DÄ internationalArchive9/2009Imaging Studies for the Early Detection of Breast Cancer: Bonn Study Was Interpreted Incorrectly

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Imaging Studies for the Early Detection of Breast Cancer: Bonn Study Was Interpreted Incorrectly

Dtsch Arztebl Int 2009; 106(9): 145. DOI: 10.3238/arztebl.2009.0145b

Schild, H H

LNSLNS The results from the Bonn study (1) were summarized in a misleading manner. The authors say that the study reported that "high grade ductal carcinoma in situ (DCIS) is often more easily detected by MRI than low grade DCIS". It has been common knowledge for many years that mammography screening obviously helps to identify many high grade DCIS. Rather, the Bonn study showed that half of the high grade DCIS remained undetected on mammography. I do not understand why the authors cite the study listed in reference 20 as contradicting the Bonn study when the results of that study are clearly consistent with those of the Bonn study: MRI shows up many additional, mammographically inapparent DCIS.

Table 1 and the authors' arguments regarding complementary ultrasonography are de facto correct but still misleading. How are readers meant to rate the information that ultrasonography enabled the detection of "4.2/1000 cancers" when it is not explained how many cancers are detected by mammography alone? Table 1 (with regard to the ACRIN 6666 study) (2) remarks that "8.8% of positive findings" were detected by ultrasonography only. Readers may gain the impression that the benefit thus derived is only marginal. In fact, of 41 cancers, only half—20—were detected by mammography alone whereas 12 additional cancers were detected by ultrasonography. This is certainly not a marginal benefit. Nine further cancers were neither detected by mammography nor by ultrasonography but were palpated as interval cancers—which underlines the "reservoir" of cancers that remain to be diagnosed by using MRI.
DOI: 10.3238/arztebl.2009.0145b

Prof. Dr. med. Hans H. Schild
Radiologische Klinik
Friedrich-Wilhlems-Universität Bonn
Sigmund-Freud-Str. 25
53105 Bonn, Germany
1.
Kuhl CK, Schrading S, Bieling HB et al.: MRI for diagnosis of pure ductal carcinoma in situ: a prospective observational cohort study. Lancet 2007; 370: 485-92 MEDLINE
2.
Berg WA, Blume JD, Cormack JB et al.: ACRIN 6666 Investigators. Combined screening with ultrasound an mammography vs. mammography alone in women at elevated risk for cancer. JAMA 2008; 299(18): 2151–63. MEDLINE
3.
Heywang-Köbrunner SH, Schreer I, Heindel W, Katalinic A: Imaging studies of the early detection of breast cancer [Bildgebung für die Brustkrebsfrüherkennung]. Dtsch Arztebl Int 2008; 105(31–32): 541–7. VOLLTEXT
1. Kuhl CK, Schrading S, Bieling HB et al.: MRI for diagnosis of pure ductal carcinoma in situ: a prospective observational cohort study. Lancet 2007; 370: 485-92 MEDLINE
2. Berg WA, Blume JD, Cormack JB et al.: ACRIN 6666 Investigators. Combined screening with ultrasound an mammography vs. mammography alone in women at elevated risk for cancer. JAMA 2008; 299(18): 2151–63. MEDLINE
3. Heywang-Köbrunner SH, Schreer I, Heindel W, Katalinic A: Imaging studies of the early detection of breast cancer [Bildgebung für die Brustkrebsfrüherkennung]. Dtsch Arztebl Int 2008; 105(31–32): 541–7. VOLLTEXT