Letter to the Editor: “Economic potential of abbreviated breast MRI for screening women with dense breast tissue for breast cancer”

by Manuel F. Granja, Luis F. Pulido, Gloria Palazuelos, Javier Romero, (manuel.granja@fsfb.org.co)

Economic potential of abbreviated breast MRI for screening women with dense breast tissue for breast cancer

Dear Editor in Chief,

In a model-based economic study, Tollens et al [1] found that abbreviated breast MRI (AB-MRI) may be considered cost-effective compared to a full protocol MRI (FB-MRI) for screening women with dense breast tissue. Reporting a cut-off that allows AB-MRI preferable in terms of cost-effectiveness (i.e., $259, up to 82% of the costs of a FB-MRI examination) is a significant landmark in supporting the actual use of AB-MRI protocols in women with dense breast tissue. We would like to share our experience in implementing abbreviated MRI protocols from the perspective of a radiology department in a developing country.

Since 2021 we have been implementing several strategies to abbreviate and optimize MRI protocols in a common effort with radiologists, technicians, fellows, and residents. The new AB-MRI protocols are based on already published material [2–4] as well as valuable input from our medical team. They suggested several modifications to multiplanar reconstructions, diffusion sequences, and ADC maps as well as the incorporation of subtraction series to create maximum intensity projections (MIPs) that reduced the total acquisition time from 24 minutes for the full diagnostic protocol to 7 minutes for the abbreviated protocol (i.e., first post-contrast subtracted images and DWI), a metric that does not reflect the total time the MRI suite is occupied (i.e., patient positioning and contrast injection). This 70% decrease in the examination time is at the expense of facing difficulties such as increased heterogeneity in the protocol application by our technologists and the still unknown indirect costs of BI-RADS 3 findings with consecutive biopsy after detection with the abbreviated breast MRI protocol as a screening modality in women with increased breast density.

Colombia, as well as other Latin-American countries, is well known for a high organizational fragmentation based on several different entities financing coverage or insurance to a significant proportion of the population. The aggregate cost for subsequent MRI screening and lack of nationwide guidelines designating breast MRI as a valid alternative for breast cancer screening makes our elaborated AB-MRI a hard sell.

To increase the external validity of significant metrics such as the ones presented by Tollens et al, it is our opinion that special emphasis on integrated delivery systems (IDSs), bundled payment models, and future costs (i.e., reductions up to 38% at 30 years) [5] should be strongly promoted and taken in consideration when discussing the true applicability of an AB-MRI protocol in real-world negotiations.