What is the accuracy of magnetic resonance mammography (breast MRI) for breast cancer imaging?

Updated: Feb 25, 2019
  • Author: Preeti Gupta, MD, FRCR; Chief Editor: Eugene C Lin, MD  more...
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Answer

In a study by Wasif et al, MRI was found to be more accurate than ultrasonography or mammography in the determination of the size of breast cancer masses. Out of 61 lesions, MRI-based tumor size was within 1 cm of pathologic size in 44 (72%) tumors, more than 1 cm above pathologic size in 6 tumors, and more than 1 cm below pathologic size in 11 tumors. [22]

Weinstein et al concluded that the addition of MRI to mammography in patients with a high risk of breast cancer has the greatest potential to detect additional, mammographically occult cancers. The investigators prospectively compared breast cancer detection of digital mammography (DM), whole-breast US (WBUS), and contrast-enhanced MRI in a high-risk screening population that previously screened negative with film screen mammography (FSM). [23]

In the Weinstein study, the cancer yield by modality was evaluated, and 20 cancers were diagnosed in 18 patients (9 ductal carcinomas in situ and 11 invasive breast cancers). The overall cancer yield on a per-patient basis was 3% (18 of 609 patients). The cancer yield by modality was 1% for FSM (6 of 597 women), 1.2% for DM (7 of 569 women), 0.53% for WBUS (3 of 567 women), and 2.1% for MRI (12 of 571 women). Of the 20 cancers detected, some were detected on only one imaging modality (FSM, 1; DM, 3; WBUS, 1; MRI, 8). [23]

Moy et al evaluated breast MRI in cases in which mammographic or ultrasonographic findings were inconclusive, and they found that MRI had a sensitivity of 100% and a significantly higher specificity than mammography (91.7% vs 80.7%, respectively). MRI also had greater positive predictive value (40% vs 8.7%) and overall accuracy (92.2% vs 78.3%). [24]

(See the images below.)

Spot compression MLO view showing two masses in th Spot compression MLO view showing two masses in the inframammary fold region.
Same patient as in the previous mammogram: Reconst Same patient as in the previous mammogram: Reconstructed T1 weighted fat-saturation sagittal image of right breast shows the two masses seen on the mammogram and a third mass more superiorly and posteriorly. The inferior-most mass shows a signal void from the biopsy clip.
Same patient as in the previous MRI: Axial T1 fat- Same patient as in the previous MRI: Axial T1 fat-saturated dynamic contrast-enhanced images show an enlarged right internal mammary lymph node.
Same patient as in the previous MRI: PET-CT showin Same patient as in the previous MRI: PET-CT showing intense hypermetabolic activity in a right internal mammary lymph node.

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