ACR Commission disputes AHRQ report on testing for breast abnormalities

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The Commission on Breast Imaging of the American College of Radiology announced its dismay in the findings of the Agency for Healthcare Research and Quality’s (AHRQ) report titled “Effectiveness of Noninvasive Diagnostic Tests for Breast Abnormalities,” published on Feb. 9th. The Commission says the report shows a fundamental lack of understanding of the basic principles of breast imaging and confusion as to what constitutes an “abnormal mammogram.” And, it says that the authors failed to recognize the difference between a screening mammogram with abnormal results and a mammogram with suspicious findings.

AHRQ’s report was comprised of a literature review and analysis to assess the effectiveness of PET, scintimammography, MRI, and ultrasound in diagnostic breast imaging. The goal was to “help patients, policymakers, and clinicians determine whether these noninvasive tests are sufficiently accurate to be appropriate for evaluation of average risk women with an abnormal mammogram or exam finding...” The authors reviewed a total of 69 publications, nine on PET imaging, 45 on scintimammography, 19 on MRI, and eight on ultrasound. They looked at sensitivity, specificity, positive and negative predictive value of the respective tests and concluded that none of the tests was sufficiently accurate to replace biopsy of suspicious abnormalities.

The report shows no appreciation of the clinical context in which the studied tests are used, says the Commission. While ultrasound is commonly and frequently employed to evaluate an abnormal screening mammogram, PET, scintimammography, and MRI are rarely, if ever, used for that purpose in actual clinical practice. In addition, the AHRQ report evaluated only eight ultrasound papers, only three of which dealt with nonpalpable findings and one of which evaluated a type of ultrasound that is not in widespread use (3-D ultrasound).