Role of MRI in Screening, Diagnosis and Management of Breast Cancer

Anil Kumar Swayampakula; Charlotte Dillis; Jame Abraham

Disclosures

Expert Rev Anticancer Ther. 2008;8(5):811-817. 

In This Article

Abstract and Introduction

Abstract

Screening and early diagnosis has an important role in reducing the morbidity and mortality associated with breast cancer. Mammography has an established role and has been approved for routine screening. MRI is an emerging tool and has the highest sensitivity of current breast imaging techniques. Although low specificity and high cost of MRI restricted its use in routine screening, it has been increasingly used in the screening of high-risk individuals, diagnosing occult cases, staging and assessing the response to chemotherapy. MRI-guided techniques, including needle-localization biopsy and vacuum-assisted breast biopsy, have a special role in diagnosis and management. This article focuses on the role of MRI in diagnosis, screening and management of breast cancer, and reviews the current indications for breast MRI.

Introduction

In the USA, breast cancer is the most common nonskin cancer and second leading cause of cancer-related deaths in women.[40] Globally, there are approximately half a million deaths annually that are related directly or indirectly to breast cancer.[41] Different diagnostic techniques have been used, including ultrasound, mammography and MRI.

At present, mammography is superior to ultrasound and is the only tool proven in randomized controlled trials to decrease mortality rates from breast cancer. Ultrasound requires a well-trained operator, and its nonstandardization of technique, high false-positive rate and inability to show microcalcifications proved mammography a better tool for screening.[1] However, previous studies have shown that mammography may miss up to 35% of malignant cases. This low sensitivity may be due to dense breasts, subtle features of malignancy, multifocal or multicentric lesions.[2]

MRI is a noninvasive imaging technique, which enables a 3D delineation process, and different MRI techniques have been developed for direct imaging of angiogenesis. Functional MRI has been introduced to correctly diagnose, differentiate and guide therapy based on functional properties of lesions, such as vascularity and perfusion, which is more apt for the current multidrug regimen, with angiogenic and cytostatic properties. Dynamic contrast-enhanced (DCE) MRI is best used for the assessment of multifocal malignancy. DCE MRI facilitates the evaluation of total extent of the disease and improves diagnostic accuracy.[3]

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