Breast MRI more accurate than mammography in diagnosing invasive cancer in high-risk women

A study by Sung et al published in Radiology found that breast MRI screening is more likely to detect invasive cancers than mammography in women at higher risk. 

The study was a retrospective review of 7,519 high-risk women due to family or personal history of breast cancer, high risk lesion, BRCA mutation status or radiation to the chest, who underwent MRI screening and mammography.

A total of 18 064 screening MR imaging examinations and 26 866 screening mammographic examinations were performed. Two hundred twenty-two cancers were diagnosed in 219 women, 167 (75%) at MR imaging, 43 (19%) at mammography, and 12 (5%) interval cancers. Median age at diagnosis was 52 years.  Cancers found at screening MR imaging were more likely to be invasive cancer 118 of 167 or 71%. Of the 43 cancers found at screening mammography, 38 (88%) manifested as calcifications and 28 (65%) were ductal carcinoma in situ. Interval cancers were associated with nodal involvement were of the triple-negative subtype.

In conclusion MRI of the breast was better than mammography in detecting invasive breast cancer in women at high risk for breast cancer.  Mammography had an advantage for the detection of calcifications and thus for ductal carcinoma in situ.

Stent Retriever Therapy of Benefit to Stroke Patients

A multicenter trial the results of which were published in Radiology by Goyal et al indicated that if a patient with acute ischemic stroke is treated within two and half hours of ictus, 91% recover with little or no disability.  However after five and a half hours, favorable outcome goes down to 41%.

Data from 196 patients enrolled in the SWIFT PRIME trial, a global, multicenter, prospective study in which outcomes of patients treated with intravenous tissue plasminogen activator tPA alone or in combination with a thrombectomy device (Solitaire by Covidien, Irvine, CA) were analyzed.

In the stent retriever arm of the study, symptom onset to reperfusion time of 150 minutes or less led to 91% estimated probability of functional independence, which decreased by 10% over the next hour and by 20% with every subsequent hour of delay. Time from arrival at the emergency department to arterial access was 90 minutes (interquartile range, 69–120 minutes), and time to reperfusion was 129 minutes (interquartile range, 108–169 minutes). Patients who initially arrived at a referring facility had longer symptom onset to groin puncture times compared with patients who presented directly to an endovascular-capable center (275 versus 179.5 minutes, P < .001).

The findings of the trial strongly suggest that fast reperfusion leads to improved functional outcome among patients with acute stroke treated with stent retrievers and tPA.