The potential utility of abbreviated breast MRI (FAST MRI) as a tool for breast cancer screening: a systematic review and meta-analysis.

AIM: To synthesise evidence comparing abbreviated breast magnetic resonance imaging (abMRI) to full-protocol MRI (fpMRI) in breast cancer screening. MATERIALS AND METHODS: A systematic search was undertaken in multiple databases. Cohort studies without enrichment, presenting accuracy data of abMRI in screening, for any level of risk (population, moderate, high risk) were included. Level of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Meta-analyses (bivariate random effects model) were performed for abMRI, with fpMRI and histology from fpMRI-positive cases as reference standard, and with follow-up to symptomatic detection added to the fpMRI. The review also covers evidence comparing abMRI with mammographic techniques. RESULTS: The title and abstract review retrieved 23 articles. Five studies (six articles) were included (2,763 women, 3,251 screening rounds). GRADE assessment of the evidence was very low because the reference standard was interpreted with knowledge of the index test and biopsy was not obtained for all abMRI positives. The overall sensitivity for abMRI, with fpMRI (and histology for fpMRI positives) as reference standard, was 94.8% (95% confidence interval [CI] 85.5-98.2) and specificity as 94.6% (95% CI: 91.5-96.6). Three studies (1,450 women, 1,613 screening rounds) presented follow-up data, enabling comparison between abMRI and fpMRI. Sensitivities and specificities for abMRI did not differ significantly from those for fpMRI (p=0.83 and p=0.37, respectively). CONCLUSION: A very low level of evidence suggests abMRI could be accurate for breast cancer screening. Research is required, with follow-up to interval cancer, to determine the effect its use could have on clinical outcome.

Comparison of the history obtained by patient-completed questionnaires with doctors' standard notes for patients with acute abdominal pain.

BACKGROUND: Studies have shown that proformas improve the information recorded by junior doctors when they clerk patients with acute abdominal pain. This increases their diagnostic accuracy, but doctors are reluctant to use them. Patient-completed questionnaires are being used in elective surgery, but can they be used for patients with acute abdominal pain? OBJECTIVE: To evaluate the history obtained by patient-completed questionnaires in patients with acute abdominal pain and compare this with the history recorded by the admitting junior doctors. DESIGN: Prospective observational study. SUBJECTS: 116 adult patients aged 17-90 admitted as an emergency to the Department of Surgery at Ysbyty Gwynedd in North Wales. MAIN OUTCOME MEASURES: Differences in the amount of information collected using patient-completed questionnaires and the history recorded by junior doctors. The questionnaires contained 17 points relating to general symptoms of the acute abdomen and five points related to gynaecological symptoms. RESULTS: Of the 116 patients studied, 100 (86.2%) completed the questionnaires. There were 60 female and 40 male patients and the median age was 49 years (range 17-90). Doctors recorded fewer than 50% of the general symptoms for acute abdominal pain and patients recorded 90% or more (p<0.0001). Doctors' documentation of gynaecological symptoms was better, but still less detailed than patients' (52-76% vs 92-100%). CONCLUSION: Patient-completed questionnaires can be used to obtain a more accurate history than junior doctors for most patients admitted with acute abdominal pain.