4 ms·

The argument for increased iatrogenic injury is always brought up with new technologies (and sometimes used to dismiss their use). In this case, presumably, y

by caycep 7y ago

The argument for increased iatrogenic injury is always brought up with new technologies (and sometimes used to dismiss their use). In this case, presumably, you mean increased amounts of invasive biopsies w/ potential complications, bleeding, pain, etc. Esp with false positives. The converse thought is, with the increased resolution, image quality and addition of a 3rd dimension over plain film mammographies, how much reduction in false positives iatrogenic can one reasonably expect?

ska 7y ago
The situation is a bit more nuanced than you suggest. MRI gives you 3D information and better tissue contrast, but much worse resolution. This makes things difficult with micro-calcifications, but really helps with some lesions in dense breasts. The best specific information comes with a contrast agent, but that's not appropriate for screening for the iatrogenic reasons you mention, but is suited to diagnostic followup. Worth noting on a big enough screening population, biopsy complications include death by infection, etc. You also have to consider the opportunity cost of the machinery and tech time, etc. So while sometimes approaches are dismissed for this (e.g. contrast agents for screening) it is not done without though. As an overall health system, too, you really have to evaluate the systemic costs and opportunity costs, particularly with a screening program. Two big variables here are the infrastructure & workflow costs for introducing MRI mammo into a screening program (those machine and tech hours come from some other worthy use) and radiologist attention. Breast screening already struggles with allowing enough time for careful review of 2D data sets, adding more information of a 3D set (potentially additionally!) means you may have to trade off increased cost/time (or reduced coverage) against FN count. So that's the tip of that particular iceberg. It's not easy, and a lot of smart people have been thinking about this since the 90s.

by caycep 7y ago

ska 7y ago

The situation is a bit more nuanced than you suggest. MRI gives you 3D information and better tissue contrast, but much worse resolution. This makes things difficult with micro-calcifications, but really helps with some lesions in dense breasts. The best specific information comes with a contrast agent, but that's not appropriate for screening for the iatrogenic reasons you mention, but is suited to diagnostic followup. Worth noting on a big enough screening population, biopsy complications include death by infection, etc. You also have to consider the opportunity cost of the machinery and tech time, etc. So while sometimes approaches are dismissed for this (e.g. contrast agents for screening) it is not done without though. As an overall health system, too, you really have to evaluate the systemic costs and opportunity costs, particularly with a screening program. Two big variables here are the infrastructure & workflow costs for introducing MRI mammo into a screening program (those machine and tech hours come from some other worthy use) and radiologist attention. Breast screening already struggles with allowing enough time for careful review of 2D data sets, adding more information of a 3D set (potentially additionally!) means you may have to trade off increased cost/time (or reduced coverage) against FN count. So that's the tip of that particular iceberg. It's not easy, and a lot of smart people have been thinking about this since the 90s.