Magnetic Resonance Imaging of the Breast Prior to Biopsy

Abstract

AMMOGRAPHY IS THE PRImary imaging modality used to detect clinically occult breast cancer. However, mammography has limitations in both sensitivity and specificity that have led to exploration of other imaging techniques. Magnetic resonance imaging (MRI) has been evaluated for breast imaging because of its value for assessing soft tissues of the body. Breast MRI is performed before and after injection of a gadoliniumbased contrast agent. 1,2 Additional lesions seen by MRI that are not visible on the mammogram have been reported to be present in between 27% and 37% of patients. 3,4 The use of MRI to evaluate women with mammographically or clinically suspicious breast lesions who are undergoing biopsy has shown high potential, with the reported sensitivities of MRI for breast cancer from larger single center studies ranging from 88% to 95%. 5-12 Thus, there has been considerable enthusiasm for breast MRI and use of the procedure for Medicare patients increased almost 3-fold between 2001 (3440 examinations) and 2003 (10 115 examinations). 13 However, the reported specificity of MRI is variable, ranging from 30% to For editorial comment see p 2779.

The impact of preoperative MRI on breast-conserving surgery of invasive cancer: a comparative cohort study

“…Some of these considerations also hold for DCIS. Moreover, variable sensitivity of MRI for the detection of pure DCIS has been observed in other studies [10,[47][48][49][50].…”

Quantitative diffusion weighted imaging for differentiation of benign and malignant breast lesions: The influence of the choice of b‐values

“…MRI of the breast has obtained a prominent role in clinical practice because of its high sensitivity for detecting invasive breast tumors (1)(2)(3). However, the specificity of DCE MRI of the breast, is substantially lower.…”

“…However, the specificity of DCE MRI of the breast, is substantially lower. It was shown to reach approximately 70% (1)(2)(3). Many different strategies have been proposed to increase the specificity such as calculating pharmacokinetic contrast parameters (4), T2*-weighted perfusion imaging (5) and MR spectroscopy (5).…”

“…The rationale is that, in malignant lesions, the cells are more densely packed than in benign lesions and normal tissue (18). This results in less space for Brownian motion of the water molecules leading to a lower Diffusion Coefficient (D [mm 2 /s]) in malignant lesions compared with that in benign lesions and normal tissue (8).…”

Computer-Aided Diagnosis Scheme for Distinguishing Between Benign and Malignant Masses in Breast DCE-MRI

“…The specificity of breast DCE-MRI, which is typically between 67 and 72 %, is lower than that of mammography. Such a low specificity results in a larger number of false positives and higher biopsy rates [8][9][10]. Furthermore, DCE-MRI requires a significant amount of time for image interpretation.…”