Why undergo a Magnetic Resonance Imaging (MRI) of the breast?

From the Guidelines

Breast MRI is recommended for high-risk breast cancer screening, particularly for women with BRCA gene mutations, strong family histories of breast cancer, or those who've had chest radiation therapy before age 30, as it has been shown to increase cancer detection and reduce interval cancers 1. The primary reasons for undergoing a Magnetic Resonance Imaging (MRI) of the breast include:

• Evaluating abnormalities found on mammograms or ultrasounds
• Monitoring response to chemotherapy
• Checking breast implants for leakage
• Examining dense breast tissue This imaging technique uses powerful magnets and radio waves to create detailed pictures of breast tissue, making it more sensitive than mammograms for detecting certain cancers. The procedure involves lying face down on a table with breasts positioned in special coils, then entering an MRI machine for 30-60 minutes while contrast dye (gadolinium) is typically administered through an IV to enhance image quality. Some key benefits of breast MRI include:
• Higher sensitivity than mammography, especially in high-risk women
• Ability to detect small, node-negative invasive cancers at earlier tumor stages
• Reduction in interval cancers However, it's essential to consider the potential drawbacks, such as:
• Higher recall rate and frequency of image-guided biopsies compared to mammography
• Higher cost and limited availability compared to other breast imaging methods Recent studies, including the 2024 update on female breast cancer screening, support the use of breast MRI as a supplemental screening tool for high-risk women, with a recommended starting age of 25 years 1. Additionally, the American College of Radiology recommends annual surveillance MRI in women with dense breasts and a personal history of breast cancer, as well as in women who were diagnosed before age 50 1.

From the Research

Reasons for Undergoing a Magnetic Resonance Imaging (MRI) of the Breast

• MRI is recommended as an adjunct to annual mammography and clinical breast examination for women who have a BRCA1 or -2 mutation or who have a first-degree relative who has a BRCA1 or -2 mutation but who have not undergone genetic testing themselves 2
• Women with a history of lobular carcinoma in situ, or those who underwent radiation treatment to the chest between 10 and 30 years of age, are also recommended to undergo MRI screening 2
• MRI is specifically recommended for patients 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) 2
• Breast MRI performs well in high-risk women, including mutation carriers, and allows for the detection of early stage, likely curable invasive breast cancer 3
• MRI screening is cost-effective in the highest risk patients, and new clinical trials are open examining abbreviated and ultra-fast MRI techniques as a tool to drive down costs and improve specificity 3

Benefits of MRI Screening

• MRI detected cancers that were not identified on mammography 6 months earlier in women who were at genetically high risk of developing breast cancer 4
• The cancer detection rate (CDR) was highest in the BRCA/RT group, intermediate for those in the PH and HRL groups, and lowest for those in the FH group 5
• No difference in CDR was evident for the PH or HRL group compared with the BRCA/RT group, but the CDR was lower for the FH group compared with the BRCA/RT group 5
• Screening breast MRI should be considered for women with a personal history of breast cancer or high-risk lesion 5
• Breast MRI is superior in identifying lesions in women with a very high risk of breast cancer or average risk with dense breasts 6

Clinical Indications for Breast MRI

• Assessment of the extent of disease 6
• Evaluation of response to neoadjuvant therapy (NAT) 6
• Evaluation of lymph nodes and primary occult tumor 6
• Evaluation of lesions suspicious of Paget's disease, and suspicious discharge and breast implants 6
• Breast MRI has benefits in numerous other clinical cases, and its application can significantly impact the correct cases of breast abnormality detection in women 6