Breast cancer MRI

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MRI of Breast Cancer. Magnetic resonance image (MRI) of individual breast, demonstrating marked enhancement (bright area) which was confirmed to be cancer. By Unknown photographer - This image was released by the National Cancer Institute, an agency part of the National Institutes of Health, with the ID 2703 (image) (next)., Public Domain, https://commons.wikimedia.org/w/index.php?curid=24052431

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Soroush Seifirad, M.D.[2], Ammu Susheela, and Mirdula Sharma.

Overview

Although a number of breast MRI indications remained controversial, breast MRI has been recommended for a variety of conditions such as studying a probable occult primary breast cancers, evaluation of disease extension, watching up the response to neoadjuvant chemotherapy, studying disease recurrence, as an adjuvant method to clarify inconclusive clinical or imaging findings, and as the recommended method of screening for high-risk patients another indication of breast MRI is assessment of silicone implant integrity.

Findings on MRI

MRI uses powerful magnetic forces and radio-frequency waves to make cross-sectional images of organs, tissues, bones and blood vessels. A computer turns the images into 3-dimensional pictures. An MRI of the breast is not routinely used to diagnose breast cancer, but may be done in certain situations to:[1][2][3]

  • Find the primary tumor in the breast
  • MRI may be used if cancer is found in the axillary lymph nodes or if a woman has Paget disease of the nipple.
  • Find out the extent of cancer in the breast tissue (local disease)
  • MRI may be used when test results from physical examination, mammography or ultrasound are not clear.
  • Hence MRI might be used as an adjuvant method to clarify inconclusive clinical or imaging findings,
  • Better examine an abnormality found on mammography
  • MRI may be used if the abnormality cannot be found with other tests, such as a clinical breast exam or breast ultrasound.
  • It may also be used if the abnormality can be seen from only one view of the results of mammography.
  • Watching up the response to neoadjuvant chemotherapy, disease recurrence,
  • MRI is the recommended method of screening for high-risk patients
  • Additionally, breast MRI is the method of choice for assessment of silicone implant integrity
  • A breast MRI is used to look at the size of cancer, shreds of evidence of metastases as well s presence of other tumors in certain cases.[4]
  • Also recommended for screening of the high-risk patients wherein serial mammography might increase the likelihood of developing cancer in them.
  • Tumor angiogenesis or neovascularity makes the foundation of application of MRI to detect breast cancer
  • Increased vasculature and hence increased permeability, increase take up and release of the contrast media and distinguish breast cancers from benign tumors
  • Tailored breast coil is essential for breast MRI.
  • Application of contrast agents such as intravenous gadolinium is recommended in order to maximize cancer detection and to highlight neovascularity.
  • Breast MRI may be used to study silicone implant integrity.
  • Evaluating silicone implant integrity. does not need contrast media.
  • Application of contrast media such as gadolinium is contraindicated in patients with renal function.
  • Breast MRI sensitivity is high, but the specificity is low
  • The available literature suggests that the sensitivity of contrast-enhanced breast MRI in the detection of cancer is considerably higher than that of either mammography or ultrasound and is generally reported to be in excess of 94%.
  • The specificity is only fair ('modest'), (or 37%-97%) thus a positive finding by MRI should not be interpreted as a definitive diagnosis.
  • Because, there is an overlap in the enhancement pattern of benign and malignant lesions.
  • The accuracy of breast MRI might be affected by hormonal changes and cancer treatment.
  • Breast MRI either with or without contrast is contraindicated in:
  • Pregnancy
  • Implanted devices and foreign bodies (exception is MRI friendly implants)
  • History of gadolinium allergy
  • Decreased renal function
  • Nephrogenic systemic fibrosis (NSF) is a systemic disease resembles scleromyxedema and to some extent scleroderma which might occur months after contrast has been injected.
  • Patients with poorer renal function are more at risk for NSF, with dialysis patients being more at risk than patients with renal insufficiency.[5]

[6][7]

References

  1. Breast cancer. Canadian Cancer Society (2015) http://www.cancer.ca/en/cancer-information/cancer-type/breast/signs-and-symptoms/?region=on#ixzz3xScycfqv Accessed on January 16, 2016
  2. Raikhlin A, Curpen B, Warner E, Betel C, Wright B, Jong R (2015) Breast MRI as an adjunct to mammography for breast cancer screening in high-risk patients: retrospective review. AJR Am J Roentgenol 204 (4):889-97. DOI:10.2214/AJR.13.12264 PMID: 25794083
  3. Mann RM, Balleyguier C, Baltzer PA, Bick U, Colin C, Cornford E et al. (2015) Breast MRI: EUSOBI recommendations for women's information. Eur Radiol 25 (12):3669-78. DOI:10.1007/s00330-015-3807-z PMID: 26002130
  4. Radhakrishna S, Agarwal S, Parikh PM, Kaur K, Panwar S, Sharma S et al. (2018) Role of magnetic resonance imaging in breast cancer management. South Asian J Cancer 7 (2):69-71. DOI:10.4103/sajc.sajc_104_18 PMID: 29721466
  5. Monticciolo DL (2017) Practical Considerations for the Use of Breast MRI for Breast Cancer Evaluation in the Preoperative Setting. Acad Radiol 24 (11):1447-1450. DOI:10.1016/j.acra.2017.05.012 PMID: 28647387
  6. Mann RM, Kuhl CK, Moy L (2019) Contrast-enhanced MRI for breast cancer screening. J Magn Reson Imaging ():. DOI:10.1002/jmri.26654 PMID: 30659696
  7. Kaewlai R, Abujudeh H (2012) Nephrogenic systemic fibrosis. AJR Am J Roentgenol 199 (1):W17-23. DOI:10.2214/AJR.11.8144 PMID: 22733927

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