Understanding indications and defining guidelines for breast magnetic resonance imaging

Abstract

Magnetic resonance imaging (MRI) of the breast is the most sensitive imaging modality for detecting cancer. With improved scan resolution and correctly applied clinical indications, the specificity of breast MRI has markedly improved in recent years. Current literature indicates an overall sensitivity for breast MRI of 98% – 100% and specificity of 88%. By comparison, the sensitivity and specificity for mammography is in the region of 71% and 98%, respectively. In particular, the very high negative predictive value (NPV) of breast MRI, which approaches 100%, is hugely useful in establishing absence of disease. Furthermore, the ability to accurately delineate viable cancer by way of combining both morphological and functional (contrast enhancement) capabilities means that MRI is the best tool we have in terms of local cancer staging and identifying residual or recurrent disease. The high NPV also means that breast MRI is uniquely capable of ruling out cancer or high-grade ductal carcinoma in situ in appropriate circumstances. I hope that the following guidelines that are based on those of the American College of Radiology and the European Society of Breast Imaging in addition to multiple review articles will provide some assistance to radiologists in terms of the correct indications for breast MRI. There are few formal guidelines in South Africa for the usage of breast MRI. In fact, there is a general paucity of guidelines in the international radiology world. The role of breast MRI in high-risk screening and identification of the primary in occult breast cancer is universally accepted. Thereafter, there is little consensus. By using some general guidelines, and bringing MRI into the discussion of multidisciplinary breast cancer management, good clinical practice and consistent decision-making can be established.

Breast Cancer—How Can Imaging Help?

“…Studies show that breast MRI has a promising role in breast cancer management and can be used in addition to mammography in diagnosing this type of neoplasia, especially in patients with dense breasts [ 40 , 41 ]. It is demonstrated that MRI has a higher sensitivity in detecting breast neoplasia than mammography and ultrasound (also in women with prostheses), which makes it an effective technique in investigating cancer recurrence [ 42 , 43 , 44 , 45 , 46 ]. Furthermore, it can detect neoplasia at an early stage, compared to mammography or US, being able to differentiate benign lesions from the benign-appearing ones [ 45 , 46 ].…”

“…It is demonstrated that MRI has a higher sensitivity in detecting breast neoplasia than mammography and ultrasound (also in women with prostheses), which makes it an effective technique in investigating cancer recurrence [ 42 , 43 , 44 , 45 , 46 ]. Furthermore, it can detect neoplasia at an early stage, compared to mammography or US, being able to differentiate benign lesions from the benign-appearing ones [ 45 , 46 ].…”

“…It is demonstrated that MRI has a higher sensitivity in detecting breast neoplasia than mammography and ultrasound (also in women with prostheses), which makes it an effective technique in investigating cancer recurrence [42][43][44][45][46]. Furthermore, it can detect neoplasia at an early stage, compared to mammography or US, being able to differentiate benign lesions from the benign-appearing ones [45,46]. However, most of the studies do not recommend using MRI in breast cancer follow up, but some of them suggest that MRI, US, and mammography are often used complementarily, for a better outcome [42,45].…”

Clinical Utility of Neoadjuvant MRI in Early-Stage Breast Cancer Patients

“…Given that BI-RADS has only recently been mandated for mammographic reports in BC, this information was unavailable in more than half of the patients included in this study, limiting the generalizability of these ndings. Nevertheless, a higher density of breast tissue has been generally accepted as an indication for MRI [22], partially due to better fat suppression and a higher resolution [14]. This is particularly relevant prior to NAT where disease extent and accurate staging are utilized for assessment of treatment response and locoregional treatment planning [24].…”

Triple Negative Breast Cancer: A Review of Present and Future Diagnostic Modalities

“…A two-step procedure typically employed to diagnose TNBC is imaging and immunohistochemistry (IHC) [ 38 ]. Imaging encompasses a mammogram, an ultrasound of the breast along with magnetic resonance imaging (MRI) [ 39 ]. A mammogram requires a minimal dosage of radiation that does not easily penetrate the breast tissues [ 40 ].…”