Providers need consensus guidelines for follow-up imaging after benign MRI-guided breast biopsies

More consistent follow-up protocols after benign concordant MRI-guided percutaneous core needle biopsies (MR-PCNBs) could lead to better overall patient care, according to a case study published in the Journal of the American College of Radiology.

“If radiologic-pathologic correlation is concordant with benign pathology, then patients may be recommended for imaging follow-up to confirm stability of imaging findings and to aid in early diagnosis of potentially false-negative results,” wrote Bhavika K. Patel, MD, Mayo Clinic in Phoenix, Arizona, and colleagues. “Studies have reported up to a 4 percent false-negative MR biopsy rate.”

The authors noted no consensus guidelines exist for follow-up imaging after a benign concordant MR-PCNB. In addition, they wrote, recommendations from the American College of Radiology, the National Comprehensive Cancer Network and other “medical literature” can be unclear at times and conflict with one another, leading to “variable radiology practices and uncertainty among breast radiologists and patients.”

Patel et al. surveyed more than 800 lead interpreting physicians about their own follow-up imaging protocols for these patients. While 84 percent of respondents worked at a nonacademic practice, 60 percent said they describe a group of radiologists as “dedicated breast imagers.” Fifty-four percent said they worked at a practice in an urban location.

Overall, short-interval MRI was the follow-up recommended by 40 percent of respondents, making it the most common. Another 32 percent of respondents said they have patients return for screening mammography.

“On univariate analysis, academic settings were more likely to recommend MRI follow-up imaging after benign concordant biopsy than nonacademic settings,” the authors wrote. “On multivariable analysis, when controlling for practice setting, dedicated breast radiologists were significantly more likely than general radiologists to recommend MRI surveillance after benign concordant biopsy. We speculate this may be because dedicated breast imaging cohorts are more familiar with issues surrounding undersampling or miss-sampling with MR-PCNB.”

The team also noted that a majority of respondents recommend a six-month follow-up as opposed to two years.

“Our preliminary study suggests that imaging follow-up protocols vary by institution and performing radiologist after benign, concordant MR-PCNB,” the authors concluded. “Attempts to reduce this variation through clear guidelines and standardization may avoid confusion among referring physicians and patients, improve allocation of limited imaging resources, and reduce inconvenience to patients.”