The acquired 123 studies comprised 13,847 breast lesions. Mean ADC values including 95% confidence intervals were calculated separately for benign and malign lesions. DerSimonian and Laird random-effects models with inverse-variance weights were used without any further correction to account for the heterogeneity between the studies. The meta-analysis was undertaken by using RevMan 5.3 software. The methodological quality of the 123 studies was checked according to the QUADAS-2 instrument. The following data were extracted from the literature: authors, year of publication, study design, number of patients/lesions, lesion type, mean value and standard deviation of ADC, measure method, b values, and Tesla strength. MEDLINE library and SCOPUS database were screened for associations between ADC and malignancy/benignancy of breast lesions up to December 2018. Additional imaging evaluations for incidental extramammary findings contributed an additional $16, on average, to the cost of each patient’s care.The purpose of the present meta-analysis was to provide evident data about use of Apparent Diffusion Coefficient (ADC) values for distinguishing malignant and benign breast lesions. Overall, 86 patients (3.7% CI 95% 3.0-4.5%) underwent further imaging and a clinically important finding was found in nine patients (0.4% CI 95% 0.2%-0.7%), including 5 undiagnosed malignancies. A total of 105 findings (4.5%) with either E3 or E4 C-RADS grades-indicating need for follow-up imaging-were analyzed with respect to management and clinical outcomes. Of the 2324 imaging reports reviewed, 391 (16.8%) had incidental extramammary findings. Incidental findings were categorized according to the computed tomography (CT) colonography reporting and data system (C-RADS) scheme. Reports were reviewed for the presence or absence of incidental extramammary findings, alongside any recommendations for further evaluation. Both screening and diagnostic studies were included for evaluation. In-Depth : A review was undertaken of breast MR imaging examinations performed over a one-year period using an institutional database. Relevant Reading: Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer These results underscore the importance of clinical practice guidelines for incidental finding management and emphasize the low prevalence of unexpected disease in patients undergoing advanced breast imaging. The primary limitation of the trial was its retrospective methodology and reliance on dictated radiology reports rather than direct image visualization. Follow-up imaging evaluation as a result of incidental findings was associated with a minimal increase in overall health care expenditures. Less than one percent of breast MR imaging studies contained clinically-significant incidental findings, the most common of which were unknown extramammary malignancies. The results suggest that a significant percentage of breast MR imaging studies contain incidental findings, and that many of these findings provoke additional radiographic evaluation. The goal of the present study was to review and evaluate the frequency of such findings on breast MR imaging and to explore the clinical impact of additional imaging with particular attention paid to patient outcomes and cost. As with any imaging test, there exists the potential for incidental findings, the frequency and significance of which are not always readily apparent. The modality has accordingly emerged as an important tool to help detect, diagnose, and stage breast cancer. Study Rundown: Breast MR imaging provides information on a wealth of physical and physiologic tissue features and depicts, with high spatial resolution, the cross-sectional anatomy of breast lesions.
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