Magnetic resonance imaging in patients with newly diagnosed breast cancer: A review of the literature

Abstract

The use of magnetic resonance imaging (MRI) in patients with newly diagnosed breast cancer remains controversial. Here we review the current use of breast MRI and the impact of MRI on short-term surgical outcomes and rates of local recurrence. In addition, we address the use of MRI in specific patient populations, such as those with ductal carcinoma in situ, invasive lobular carcinoma, and occult primary breast cancer, and discuss the potential role of MRI for assessing response to neoadjuvant chemotherapy. Although MRI has improved sensitivity compared with conventional imaging, this has not translated into improved short-term surgical outcomes or long-term patient benefit, such as improved local control or survival, in any patient population. MRI is an important diagnostic test in the evaluation of patients presenting with occult primary breast cancer and has shown promise in monitoring response to neoadjuvant chemotherapy; however, the data do not support the routine use of perioperative MRI in patients with newly diagnosed breast cancer. Cancer 2014;120:2080-9. V C 2014 American Cancer Society.KEYWORDS: magnetic resonance imaging (MRI), breast cancer, breast-conserving surgery, local recurrence. INTRODUCTIONThe use of magnetic resonance imaging (MRI) in patients with newly diagnosed breast cancer requires balancing the positive and negative aspects of additional imaging and, as evidenced by the growing number of editorials and reviews arguing for or against the routine use of MRI, 1-8 remains an area of significant controversy. This debate has been fueled by inconsistent data largely comprised of small, single-institution retrospective studies, although 2 randomized controlled trials (RCTs) and several meta-analyses have provided more robust data evaluating MRI in the perioperative setting. The "pros" of perioperative MRI include improved sensitivity compared with conventional imaging and therefore increased identification of multifocal, multicentric, or contralateral disease. With improved sensitivity comes a theoretical improvement in short-term surgical management and/or long-term outcomes. The "cons" of perioperative MRI include the high falsepositive rate, potential treatment delays, increased mastectomy rates and cost, and, some argue, overdiagnosis and overtreatment of MRI-only detected disease. Here we review the relevant data regarding MRI use in patients with newly diagnosed breast cancer, examining both the short-term and long-term outcomes, MRI use in populations of women with ductal carcinoma in situ (DCIS) and invasive lobular carcinoma (ILC), MRI's role in patients presenting with occult primary breast cancer, and MRI's ability to evaluate neoadjuvant chemotherapy (NAC) response.

Abbreviated Screening Protocol for Breast MRI

“…B reast magnetic resonance imaging (MRI) has been shown to have the highest sensitivity of all imaging modalities for the detection of breast cancer, a critically important factor in screening (1)(2)(3)(4)(5)(6)(7). The high sensitivity of breast MRI is largely because of improved contrast over mammography, particularly in women with dense breast tissue (1,8,9).…”

Breast Cancer Recurrence in Patients with Newly Diagnosed Breast Cancer without and with Preoperative MR Imaging: A Matched Cohort Study

“…has further limited the role of preoperative MR imaging for the ipsilateral breast (8). However, the role of preoperative MR imaging for the contralateral breast of women with newly diagnosed breast cancer remains controversial.…”

The critical nature of the multidisciplinary management of breast cancer: Not just an academic institutional exercise

“…BRCA positivity] is a reasonable indication for MRI. Routine use of MRI has been associated with increased morbidity and higher unnecessary mastectomy rates [2] . A standardized multidisciplinary approach improves coordination of care and allows for the free flow of ideas leading to improved diagnostic outcomes potentially decreasing unnecessary and potentially confounding imaging.…”