Uses include: evaluation of the breast for a suspected occult cancer in the presence of an axillary node metastasis, to determine the extent of tumor in a patients with breast cancer and to evaluate the contralateral breast, to monitor response to neoadjuvant therapy in breast cancer ad the determine extent of resection required, to screen patients with very high risk for developing breast cancer, and to help evaluate clinical or imaging suspicious lesions after mammographic and sonographic evaluations.
Increases the number of abnormalities detected by 27-36% over mammograms.
No data supports MRI of the breast as a screening technique.
Breast MRI may be a useful annual screening technique in women at the highest risk for breast cancer (>50%) such as those with genetic mutation carrier status.
Breast MRI wife is the highest cancer detection rate of all breast imaging modalities.
While multiple studies indicate MRI of the breast is more sensitive than mammography in detecting breast cancer it has lower specificity and substantially higher cost, is more invasive, and requires an intravenous injection of contrast material.
Presently there are no randomized trials to determine whether the use of breast MRI decreases breast cancer mortality more then the use of mammography.
Breast MRI use should be limited to patients with increased risk of breast cancer, such as women with genetic mutations, strong family history of breast cancer, or for selected clinical situations.
Breast imaging is twice associated sensitive and three times more specific than mammograms in detecting breast cancers that are radiologically and clinically occult.
MRI of breast not affected by breast density.
Very sensitive but not particularly specific in diagnosing additional areas of cancer within the ipsilateral or contralateral breast in a newly diagnosed breast cancer patient.
MRI can find additional lesions in newly diagnosed breast cancer cases in 40-50% of patients, leading to additional biopsies change in management in a significant number of women.
Useful in staging of local breast disease.
Among women with dense breasts undergoing screening breast MRI there is significantly higher rate of invasive cancer detection than digital breast tomosynthesis (Comstock CE).
Identification of suspicious areas often lead to unnecessary biopsies with questionable effects on outcomes.
An important supplemental diagnostic tool for invasive cancers because of its high sensitivity in detecting of ovcult disease that may otherwise go unrecognized by clinical exam, mammograms or ultrasound.
Associated with a high rate of false positive findings and can overestimate the extent of disease that may result in unnecessary biopsies and more extensive surgery.
In a meta-analysis of 44 studies showed an overall specificity of 72% compared with a sensitivity of 90% (Peters NH et al).
MRIs specificity for diagnosing breast cancer ranges from 21-100%.
Studies reveal that in patients with clinically or mammographically suspicious malignant lesions MRI is 88% sensitive, 67% specific with a positive predictive value for malignancy at 72% compared to 53% for mammography.
A study of 649 women with a strong family history of breast cancer utilizing mammography and MRI over 2-7 years revealed a sensitivity of 77% for the diagnosis new breast cancers by MRI vs 40% for mammography, with a specificity of 93% for mammograms and 81% for MRI.
In patients with BRCA mutations screening examinations have shown a sensitivity of 75-80% for the detection of breast cancer in such a population.
In patients with a previous breast cancer with a moderate risk (lifetime risk of 15-49%) for the development of a breast cancer in such a population, less than one case of additional cancer will be detected by MRI screening per 100 woman years of screening.