Preoperative Breast MRI: Current Evidence and Patient Selection

Abstract

Breast MRI is the most sensitive imaging modality for the assessment of newly diagnosed breast cancer extent and can detect additional mammographically and clinically occult breast cancers in the ipsilateral and contralateral breasts. Nonetheless, appropriate use of breast MRI in the setting of newly diagnosed breast cancer remains debated. Though highly sensitive, MRI is less specific and may result in false positives and overestimation of disease when MRI findings are not biopsied prior to surgical excision. Furthermore, improved anatomic depiction of breast cancer on MRI has not consistently translated to improved clinical outcomes, such as lower rates of re-excision or breast cancer recurrence, though there is a paucity of well-designed studies examining these issues. In addition, current treatment paradigms have been developed in the absence of this more accurate depiction of disease span, which likely has limited the value of MRI. These issues have led to inconsistent and variable utilization of preoperative MRI across practice settings and providers. In this review, we discuss the history of breast MRI and its current use and recommendations with a focus on the preoperative setting. We review the evidence surrounding the use of preoperative MRI in the evaluation of breast malignancies and discuss the data on breast MRI in the setting of specific patient factors often used to determine breast MRI eligibility, such as age, index tumor phenotype, and breast density. Finally, we review the impact of breast MRI on surgical outcomes (re-excision and mastectomy rates) and long-term breast recurrence and survival outcomes.

Breast Radiologists’ Perceptions on the Detection and Management of Invasive Lobular Carcinoma: Most Agree Imaging Beyond Mammography Is Warranted

“…Nearly all radiologists (320/329, 97%) reported a lack of confidence in assessing extent of ILC disease on mammography in dense breasts, and nearly half (162/329, 49%) felt similarly if breasts were nondense. Preoperative MRI for staging ILC is currently recommended by several guidelines in the United States and Europe, including the ACR (2018), National Institute for Health and Care Excellence (2018), American Society of Breast Surgeons (2017), European Society of Breast Imaging (2008), European Society of Breast Cancer Specialists (2010), and German Gynecological Oncology Group (2018) ( 19 ). The National Comprehensive Cancer Network (2023) recommendation for preoperative MRI is optional for evaluating the extent of ILC that is poorly defined on mammography, US, or physical examination ( 44 ).…”

“…Although the sonographic appearance of ILC can be variable and nonspecific, US is not limited by breast density and may be a valuable adjunct in detecting mammographically occult ILC ( 12–14 ). Contrast-enhanced MRI has the highest sensitivity for ILC and is valuable in defining extent of disease in women with ILC ( 3 , 12 , 19 , 20 ). However, its use as a screening tool is currently limited to certain groups of women who are at an elevated risk for breast cancer ( 21 ).…”

Towards Agility in Breast Cancer Treatment Principles as Adopted from Agile Software Engineering

“…For example, MRI assists the oncologist by providing frequent information that influences the decision of surgical management. [34][35][36] • Adjusting dosages and treatment intensity: BCT professionals may change the amount or intensity of chemotherapy, radiation therapy, or targeted therapy based on the patient's reaction and side effects to improve treatment outcomes while controlling adverse side effects. For example, new risk factors can be identified from low relative dose intensity (RDI) that may enhance radiotherapy treatment delivery.…”

Implications of Agile Values in Software Engineering for Agility in Breast Cancer Treatment: Protocol for a Comparative Study

“…This information is essential in determining an appropriate treatment approach that is ready to respond to changes. A major change in the treatment plan may involve the need for surgery and additional treatment [62][63][64].…”