:::: FOR OUR REFERRING PHYSICIANS : NEWSLETTER :.

Breast MRI

Dear Colleagues:

Pacific Breast Center is providing Breast MRI imaging services to the referring community. Because of some expressed uncertainty about the role of breast MRI in the workup and management of breast disease and its use in breast cancer screening, we have prepared a list of clinical indications for which we are using breast MRI. It is our hope that you will find this information helpful in understanding the benefits and limitations of breast MRI.

We invite your questions and welcome the opportunity to consult with you about the breast imaging needs of your patients.

Sincerely,

G.W. Eklund, M.D., FACR

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Pacific Breast Center

1500 NW Bethany Blvd., Suite 130 ♦ Beaverton, OR 97006 ♦ (503)-619-1150

G.W. Eklund, M.D., FACR; Paul Meunier, M.D.; Jane Bedell, M.D.

Clinical Indications for Breast MRI*

• Lobular cancer:Invasive lobular carcinoma (ILC) can be very difficult to detect clinically or mammographically. ILC is commonly multi-focal or multi-centric (30%), or bilateral (10%) and is a frequent cause of positive surgical margins.
• Occult breast cancer:About 3% of breast cancers present with malignant axillary nodes with no palpable breast concerns or mammographic abnormalities. The traditional management of these patients has been mastectomy. MRI can locate the primary lesion in most of these cases, allowing breast-conserving surgery.
• Minimizing close or positive surgical margins:  Inadequate margins are common (up to 50%) after lumpectomy and require additional surgery. The size or full extent of many breast cancers is difficult to define mammographically. MRI can often locate residual or additional tumors. If used pre-operatively in selective cases, MRI can decrease re-operative rates and improve surgical planning.
• Post-operative scar vs. tumor recurrence: Post-operative fat necrosis and scarring may be mammographically indistinguishable from an invasive carcinoma, making differentiation between recurrence and scar very difficult. Six months following surgery, surgical scars usually do not enhance, while recurrent tumor usually shows a characteristic pattern of enhancement that allows detection.
• High-risk screening (Breast cancer gene; Prior lymphoma treatment): These women are at great risk for breast cancer. MRI and ultrasound are useful adjuncts to mammography in these high-risk women; however, MRI is not appropriate for general screening.
• Neo-adjuvant chemotherapy or brachytherapy:MRI improves accuracy of staging by tumor size and nodal status as well as documenting therapeutic response.
• Suspected multiple or bilateral cancers: MRI often detects multi-focal, multi-centric or bilateral cancers and has a high negative predictive value; i.e., a negative MRI significantly improves diagnostic confidence. Unsuspected contralateral tumors are detected in 3-6% of cases.
• Implants: MRI is not adversely affected by implants or silicone in the soft tissues. MRI offers the most definitive test for identifying rupture of silicone implants. Women with a history of silicone injections may benefit from MRI screening.
• Problematic mammogram: In carefully selected cases MRI may be helpful in resolving equivocal or suspicious mammographic findings. Detailed mammographic evaluation and ultrasound MUST be done first, however.
• Defining the extent of high nuclear grade DCIS: Higher grades of DCIS are often well seen with MRI.

IMPORTANT NOTE - MRI and ultrasound may not detect some in situ carcinomas and some benign or low-grade malignant lesions. MRI is an adjunct to mammography. The detection of in situ carcinoma is primarily a mammography issue.