Letter to the Editor: “Magnetic resonance imaging in diagnosis of indeterminate breast (BIRADS 3 & 4A) in a general population”

Authors: Silvia González-Gómez1, 2, Natalia Rueda-Ruiz1, Nelson Bedoya1, Maria Alejandra Rueda1,2

Affiliations: 1. Fundación Santa Fe de Bogotá, Calle 119 # 7-75, 11001000, Colombia
2. Universidad El Bosque, No 131 A, Ak. 9 #131a2, Bogotá, Colombia

Dear Editor-in-Chief,

We have read with great interest the article written by Hernandez et al. “Magnetic resonance imaging in the diagnosis of indeterminate breast (BIRADS 3 & 4A) in a general population” [1]. This is an article of great interest to us, as it reiterates the importance for studies in ultrasound and mammography to be carried out by personnel trained in breast imaging. Furthermore, it has been shown that screening with these two diagnostic modalities (ultrasound and mammography) increases sensitivity even up to 90% in experienced hands [2]. Additionally, they are complementary studies with magnetic resonance imaging (MRI), which can reclassify the patients’ pathology [3].

MRI is an expensive resource and not widely available in low to middle-income countries such as Colombia. Therefore, according to the ACR criteria, patients should be evaluated with mammography and ultrasound as an initial approach to correctly classify patients according to the breast screening algorithm [4]. Only use complementary studies such as MRI in patients who need it [3].

The findings obtained by Hernandez et al., where 81.9% of the patients were re-categorized to BIRADS 1 or 2, avoiding 64.7% of the biopsies, raises the question if maybe the patients observed by MRI were previously evaluated by them, experts on breast imaging, on the ultrasound and mammography images, outcomes could improve. Perhaps the biopsy would have been avoided, and the amount of MRI for reclassification would be lower, thus reducing costs since the authors only had the reports and not the previous images.

There is no doubt that the combination of ultrasound, mammography, and resonance allows us to obtain a sensitivity that varies from 94 to 100% [3]. In Hernandez et al, outcomes only 12.38% of the patients reported both studies, perhaps posing a suboptimal initial categorization as the patients were evaluated first by a radiologist who was not an expert in breast imaging. It is important to emphasize that in low to middle-income countries, such as Colombia, having all the images interpreted by breast radiology specialists avoids unnecessary costs of additional studies such as MRI and additional biopsies.



[1] Hernández L, Díaz GM, Posada C et al (2021) Magnetic resonance imaging in diagnosis of indeterminate breast (BIRADS 3 & 4A) in a general population. Insights Imaging DOI: 10.1186/s13244-021-01098-z.
[2] Ohuchi N, Suzuki A, Sobue T et al (2016) Sensitivity and specificity of mammography and adjunctive ultrasonography to screen for breast cancer in the Japan Strategic Anti-cancer Randomized Trial (J-START): A randomised controlled trial. Lancet  DOI: 10.1016/S0140-6736(15)00774-6.
[3] Mann RM, Cho N, Moy L (2019) Breast MRI: State of the art. Radiology DOI: 10.1148/radiol.2019182947.
[4] Lee CS, Monticciolo DL, Moy L (2020) Screening guidelines update for average-risk and high-risk women. AJR Am J Roentgenol DOI: 10.2214/AJR.19.22205.