Thoracic MRI is NOT appropriate for breast cancer screening or evaluation
For breast cancer screening or evaluation of suspicious breast findings, you need a dedicated BREAST MRI (with and without IV contrast), not a thoracic MRI. These are fundamentally different examinations with different protocols, sequences, and diagnostic capabilities.
Why Breast MRI, Not Thoracic MRI
- Breast MRI is specifically designed with dedicated breast coils, dynamic contrast-enhanced sequences, and protocols optimized for detecting breast malignancy 1
- Thoracic MRI examines the chest cavity (lungs, mediastinum, chest wall) and is not designed or validated for breast cancer detection
- The ACR Appropriateness Criteria explicitly recommend "MRI breast without and with IV contrast" as the appropriate modality for high-risk screening, not general thoracic imaging 1
When Breast MRI is Indicated
High-Risk Women (Usually Appropriate)
- BRCA mutation carriers: MRI sensitivity reaches 85-94% compared to only 25-33% for mammography 1, 2
- History of chest/thoracic radiation before age 30: Begin screening 8 years after radiation but not before age 25 1
- Lifetime breast cancer risk ≥20-25% based on risk models 1
- Personal history of breast cancer diagnosed before age 50 or with dense breasts: CDR of 9-15 per 1,000 with MRI 1
Performance Data
- In high-risk women, breast MRI combined with mammography achieves 91-98% sensitivity 1
- Breast MRI detects 14.9-16 cancers per 1,000 high-risk women screened 1
- MRI detects smaller, node-negative invasive cancers at earlier stages and reduces interval cancers 1
Critical Implementation Points
- Breast MRI must be performed at experienced facilities with MRI-guided biopsy capability 1
- Breast MRI is complementary to, not a replacement for, mammography/DBT in high-risk screening 1
- Trade-offs include higher recall rates (15.1% vs 6.4% for mammography) and more biopsies (11.8% vs 2.4%) 1
Common Pitfall to Avoid
Do not order a "thoracic MRI" or "chest MRI" when evaluating breast concerns. The correct order is "breast MRI with and without IV contrast" or "abbreviated breast MRI with IV contrast" 1. Using the wrong imaging protocol will result in inadequate evaluation and missed cancers.