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Screening

Should I get a whole-body MRI screening scan?

When a healthy population was scanned, what went up was not diagnoses. It was biopsies that found nothing.

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2 cited
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Answer

The published evidence shows it generating procedures rather than answers. In the Study of Health in Pomerania, 3,371 of 6,753 participants had whole-body magnetic resonance imaging and 8,208 incidental findings were disclosed to 4,707 participants, after which biopsy rates rose from 6.9 to 9.9 per 100 observation years — and the rise fell disproportionately on biopsies that found nothing malignant, with a non-malignant biopsy rate ratio of 1.39 (95% CI 1.22 to 1.58) among participants who received a disclosure against 1.09 (0.85 to 1.38) among those who did not.

Key takeaways

  • The Study of Health in Pomerania examined 6,753 participants between 2008 and 2012; 3,371 (49.9 percent) had whole-body MRI.
  • 8,208 incidental findings were disclosed to 4,707 participants — 6,839 laboratory values outside reference limits and 1,369 from the MRI itself.
  • Biopsy rates rose from 6.9 per 100 observation years in the two years before participation to 9.9 in the two years after.
  • Among participants who received a disclosure the non-malignant biopsy rate ratio was 1.39 (95% CI 1.22 to 1.58).
  • Among those who did not receive a disclosure it was 1.09 (95% CI 0.85 to 1.38) — an interval crossing 1.
  • The extra biopsies were therefore concentrated in the people told about a finding, and disproportionately returned nothing malignant.
  • No whole-body screening MRI programme has been shown to reduce mortality in a general population.

Whole-body MRI screening is offered privately in Korea on the premise that imaging everything at once catches what a targeted test would miss. A German population cohort scanned about half of its participants and then counted what happened to them, which is the measurement that premise needs.

What the scanning produced

8,208 incidental findings were disclosed to 4,707 participants. Biopsy rates rose from 6.9 to 9.9 per 100 observation years between the two years before participation and the two years after. So the scanning did change what happened next — it sent people for tissue.

1.39 vs 1.09

rate ratio for biopsies returning nothing malignant, in participants who received an incidental-finding disclosure versus those who did notRichter A et al., European Journal of Epidemiology, 2020

The direction of that split is the finding. Among people who received a disclosure, the rate of biopsies that found no cancer rose clearly. Among those who did not, the equivalent ratio was 1.09 with a confidence interval crossing 1 — no detectable change. The procedures generated by the scan were concentrated in the people it gave something to worry about, and they disproportionately found nothing.

The cost this describes

The Korean precedent

Korea has the clearest national example of what population imaging does. Thyroid ultrasound, added opportunistically to checkups, was followed by an incidence curve that rose more than tenfold while the mortality rate did not follow it. The same nationwide analysis that documented the association between screening and the epidemic is the reason Korean clinicians are more cautious about opportunistic imaging than the marketing suggests.

None of this establishes that whole-body MRI is useless for every purpose. It establishes that as a screening test offered to people without symptoms, the measured effect is more biopsies rather than better outcomes, and no programme has been shown to reduce mortality in a general population.

Sources

  1. 1

    Richter A, Sierocinski E, Singer S, Bülow R, Hackmann C, Chenot JF, Schmidt CO

    The effects of incidental findings from whole-body MRI on the frequency of biopsies and detected malignancies or benign conditions in a general population cohort study

    European Journal of Epidemiology 2020;35(10):925-935

    doi:10.1007/s10654-020-00679-4 · PMID:32860149

    https://doi.org/10.1007/s10654-020-00679-4
  2. 2

    Park S, Oh CM, Cho H, Lee JY, Jung KW, Jun JK, Won YJ, Kong HJ, et al.

    Association between screening and the thyroid cancer epidemic in South Korea: evidence from a nationwide study

    BMJ 2016;355:i5745

    doi:10.1136/bmj.i5745 · PMID:27903497

    https://doi.org/10.1136/bmj.i5745