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Richard J. Bleicher, MD
Attending Surgeon
Monica Morrow, MD
Chairman
Department of Surgical Oncology
Fox Chase Cancer Center
Philadelphia, Pennsylvania
Abstract
Increasing experience with magnetic resonance imaging (MRI) has raised important questions about how it should be used in breast cancer screening, and for presurgical evaluation and posttherapy follow-up of women with this disease. Overall, the availability of MRI as an adjunct to mammography and ultrasound offers clear clinical benefit to women at increased risk of breast cancer development due to BRCA1 and BRCA2 mutations, and to women presenting with axillary adenopathy and an occult primary breast tumor. In contrast, its benefit for routine selection of breast conservation or further assessment of lobular carcinoma in women of average risk has not been demonstrated.This article reviews the use of MRI in these settings, with an emphasis on the clinical outcomes that have been observed to date.
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Breast imaging has two distinct roles: to screen asymptomatic women in an effort to detect cancer that is likely to be cured by therapeutic interventions, and to assist in the selection of local therapy. For many years, mammography was the only modality available for these purposes. The local therapy of breast cancer has changed dramatically over the past 30 years, and breast-conserving therapy (BCT) and neoadjuvant therapy for operable cancers have become part of routine clinical practice. Our understanding of breast cancer risk has also evolved with the recognition of the BRCA1 and BRCA2 genetic mutations, allowing the identification of a subset of women at extremely high risk of breast cancer development.
In parallel with these changes, imaging techniques have also evolved. Ultrasound is now routinely used in the evaluation of the patient with known cancer, although its role in screening remains controversial. Magnetic resonance imaging (MRI) of the breast was added to the diagnostic armamentarium of the physician in 1984. Increasing experience with this technology has raised important questions about how it should be used in screening, and for presurgical evaluation and posttherapy follow-up of women with breast cancer. This article will review the use of MRI in these settings, with an emphasis on the clinical outcomes that have been observed to date.
Screening
Mammography remains the standard of care for screening and detection of breast cancer....