Breast MRI is essential for correct surgical decision-making in patients with breast cancer

 

 

 

In women with suspected breast cancer the aim of diagnostic imaging is to detect and accurately diagnose malignant tumors and to facilitate the correct choice of therapy, be it mastectomy or breast-conserving surgery with or without pre-operative neoadjuvant chemotherapy. Although conventional mammography and ultrasound are primary imaging modalities for women with breast cancer they have limited sensitivity and specificity, and are associated with an increased likelihood of inappropriate patient management if therapeutic decisions are made solely on the basis of mammography and ultrasound findings. A study by Pediconi et al. confirmed that contrast-enhanced breast MRI is superior to conventional mammography and ultrasound not only in terms of diagnostic performance but also in terms of patient management decisions. In their study 164 consecutive women with 175 lesions detected at conventional mammography/ultrasound subsequently underwent pre-operative MultiHance-enhanced breast MRI. The MRI examination revealed 51 additional lesions in 34/164 patients. Specifically, multifocal and multicentric cancer was detected in 7 and 4 additional patients, respectively, contralateral foci in 21 additional patients and pectoral muscle infiltration in 2 additional patients. A further 4 patients suspected of having cancer based on mammography/ultrasound were confirmed to be cancer-free on MRI. The sensitivity and accuracy for malignant lesion detection and identification was 100% and 93.4%, respectively, for MultiHance-enhanced breast MRI compared to 77.3% and 72.1 %, respectively for mammography/ultrasound. Based on MRI findings patient management was altered for 32/164 (19.5%) patients; either more extensive surgery with or without additional chemotherapy for 28 patients with unsuspected additional disease or a conservative approach for the 4 patients without malignant lesions. The study highlights not only the need for careful pre-operative work-up of women with suspected breast cancer but also the limitations of conventional breast imaging techniques.

 

 

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