Fueger Barbara J, Tollens Fabian, Kaiser Clemens G N, Helbich Thomas H, Pötsch Nina, Clauser Paola, Baltzer Pascal A T
Division of General and Pediatric Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.
Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany.
Insights Imaging. 2025 Jun 12;16(1):122. doi: 10.1186/s13244-025-01990-y.
To evaluate the cost-effectiveness of supplemental breast magnetic resonance imaging (MRI) in women with BI-RADS 4 mammographic microcalcifications in order to avoid unnecessary stereotactic biopsies.
Decision analysis and Markov modeling were used to compare the short-term costs and effects of two diagnostic strategies: supplemental breast MRI in women with mammographic microcalcifications to avoid needle biopsies in MRI negative cases vs stereotactic biopsies of all BI-RADS 4 microcalcifications.
Applying supplemental breast MRI resulted in comparable costs and outcomes. Average cumulative costs of US$ 56,918 and 2.932 quality adjusted life years (QALYs) per woman were achieved for the supplemental breast MRI-strategy, whereas stereotactic biopsies as standard of care resulted in cumulative costs of US$ 56,898 and 2.930 QALYs, resulting in an incremental cost effectiveness ratio (ICER) of US$ 10,047 per QALY gained.
Due to comparable diagnostic safety at similar costs, the non-invasive breast MRI alternative for workup of mammographically detected suspicious calcifications should be offered to patients within the context of shared decision making.
Contrast-enhanced MRI of the breast should be offered as an alternative to stereotactic biopsy within the context of shared decision-making.
Breast MRI and stereotactic biopsy enable accurate risk stratification of suspicious calcifications. Breast MRI and stereotactic biopsy yield comparable cost-effectiveness and clinical outcomes. Breast MRI should be considered as an option regarding shared clinical decision-making.
评估乳腺磁共振成像（MRI）对乳腺影像报告和数据系统（BI-RADS）4类乳腺钼靶微钙化女性的成本效益，以避免不必要的立体定向活检。
采用决策分析和马尔可夫模型比较两种诊断策略的短期成本和效果：对乳腺钼靶微钙化女性进行补充乳腺MRI检查，以避免MRI阴性病例的穿刺活检，与对所有BI-RADS 4类微钙化进行立体定向活检。
应用补充乳腺MRI检查的成本和结果相当。补充乳腺MRI策略每位女性的平均累计成本为56,918美元，质量调整生命年（QALY）为2.932，而作为标准治疗的立体定向活检累计成本为56,898美元，QALY为2.930，每获得一个QALY的增量成本效益比（ICER）为10,047美元。
由于在相似成本下诊断安全性相当，应在共同决策的背景下为患者提供用于评估乳腺钼靶检测到的可疑钙化的非侵入性乳腺MRI替代方法。
在共同决策的背景下，应提供乳腺对比增强MRI作为立体定向活检的替代方法。
乳腺MRI和立体定向活检能够对可疑钙化进行准确的风险分层。乳腺MRI和立体定向活检产生相当的成本效益和临床结果。在共同临床决策方面，应考虑将乳腺MRI作为一种选择。
