What are the NCCN guidelines on breast cancer screening and diagnosis using MRI?

Updated: Oct 17, 2016
  • Author: Nagwa Dongola, MD, FRCR; Chief Editor: Peter Eby, MD  more...
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Answer

The 2009 National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology for Breast Cancer Screening and Diagnosis include using breast MRI for screening as an adjunct to annual mammography and clinical breast examination in the following situations [30] :

  • In women who have a BRCA1 or BRCA2 mutation or who have a first-degree relative who has a BRCA1 or BRCA2 mutation but who have not undergone genetic testing themselves.

  • In those who are determined to have a lifetime risk greater than 20% based on models that are highly dependent on family history.

  • In those with a history of lobular carcinoma in situ.

  • In patients who underwent radiation treatment to the chest between 10 and 30 years of age.

  • In women who carry or have a first-degree relative who carries a genetic mutation in the TP53 or PTEN genes (Li-Fraumeni, Cowden, and Bannahyan-Riley-Ruvalcaba syndromes).

According to the NCCN, MRI is specifically not recommended for screening women at average risk for breast cancer. MRI is also not generally recommended as a problem-solving tool when mammographic, sonographic, or physical examination findings are equivocal. As stated, the addition of MRI may result in additional false-positive findings and does not obviate the need for biopsy. Tissue sampling is preferred for these situations, because it will directly answer the question in a relatively rapid and inexpensive manner. [31]

 


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