Newer imaging technologies are not adequate to rule out the need for a breast biopsy following an abnormal mammogram, a Feb. 9 Agency for Healthcare Research & Quality report concludes.

But the American College of Radiology says the study is not based on realistic clinical practice.

In the analysis, carried out by AHRQ's comparative effectiveness review program, a scientific panel evaluated 81 published studies involving magnetic resonance imaging, positron emission tomography, scintimammography and ultrasound to assess the sensitivity and specificity of these procedures. The goal was to consider if the screening technologies could be used to avoid a somewhat invasive biopsy.

The report cited a 2003 study by the Ontario Ministry of Health that concluded that a diagnostic test that gave false-negative results 2% of the time or less would be acceptable to reliably preclude breast biopsy. By this threshold, "none of these tests was sufficiently accurate," AHRQ suggests.

However, according to Carol Lee, MD, chair of the American College of Radiology Breast Cancer Imaging Commission, it is not standard, nor is it being contemplated, to employ a single imaging test to rule out biopsy after a suspicious or inconclusive mammogram. The AHRQ report reflects a "lack of understanding" of clinical practice, she said in an interview.

Lee explained that a biopsy is necessary if a mammogram shows a suspicious abnormality. But imaging tools such as MRI or PET scans can provide additional information about the disease. Furthermore, she noted, if a mammogram is inconclusive, physicians apply a multi-step process that includes imaging and other considerations to determine whether biopsy and other follow-up is required.

"Women should not be misled by this report into thinking that additional imaging evaluation after an inconclusive screening mammogram is unnecessary or inaccurate," she said.

The AHRQ study comes in the midst of a national debate on the cost-effectiveness of imaging procedures and government efforts to reduce Medicare payments for such procedures (¹ Also see "Gainsharing Demo Program, Medicare Imaging Cuts Included In Budget Bill" - Medtech Insight, 2 January, 2006., p. 10).

Newer Imaging Technologies Not An Alternative To Biopsy, AHRQ Says

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