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Indications for Use of Breast Magnetic Resonance Imaging (MRI) Guideline Summary

Date:
(O): June 30, 2011 (R):
Date Signed:
November 26, 2012
Tumor Group:
Breast Disease Site Group
Issuing Authority:
Dr. Rick Bhatia, Clinical Chief,
Diagnostic Imaging, Eastern Health
Adapted From:
Alberta Health Services “magnetic resonance imaging for breast cancer screening, pre-operative assessment, and follow-up” guideline, October 2010 (8).
 

Target Population:
Patients who meet the criteria for the use of breast magnetic resonance imaging (MRI).

Recommendations:
Patients, who otherwise have no contraindications, are eligible for magnetic resonance of the breast when they meet at least one of the clinical indicators for its use.

Clinical Indicators:
1. Screening of high risk individuals, those with:

  • Genetic predisposition* (proven or presumptive) (1-5)
  • Past history of mediastinal radiation between ages of 10 and 30 (6).

2. Problem solving when mammographic, sonographic or clinical findings are suspicious but inconclusive, such as:

  • Inconclusive findings of breast cancer (7)
  • Pre-operative MRI (8)

3. Assessment of positive margins following breast cancer surgery

  • Previous lumpectomy (9-11)

4. Differentiation of post-surgical scarring from recurrent tumor (7,12,13)

5. Search for source of primary malignancy when the breast is normal by conventional imaging in the presence of tumor positive axillary adenopathy (14-16)

6. Assessment of response to neoadjuvant chemotherapy (17,18)

7. Assessment of breast implant integrity (19,20).

* For a detailed description of proven or presumptive genetic predisposition, review the Breast Disease Site Group’s “breast magnetic resonance imaging and high risk hereditary breast cancer” guideline.

Qualifying Statements:

  • Breast MRI does not replace conventional imaging (ie. mammography or ultrasound) and physical examination. A negative breast MRI also does not exclude the presence of malignancy or preclude the appropriate management of an otherwise suspicious finding.
  • Magnetic Resonance Imaging (MRI) has been shown to be superior in sensitivity to mammography, but significantly lower in specificity, resulting in a higher false-positive rate. Therefore, the recommendation would be for its use in screening only those patients deemed to be at high risk.
Note:
Breast MRI should be scheduled during the second week of the menstrual cycle (days 5 to 13) in premenopausal women. Occasionally, areas of normal hormonally sensitive breast tissue may enhance intensely on MRI which could result in a false positive reading. Therefore, examination is best performed in mid-cycle (21).

Disclaimer:

These guidelines are a statement of consensus of the Breast Disease Site Group regarding their views of currently accepted approaches to diagnosis and treatment. Any clinician seeking to apply or consult the guidelines is expected to use independent medical judgment in the context of individual clinical circumstances to determine any patient’s care or treatment.

Contact Information:
For more information on this guideline, please contact:

Dr. Nancy Wadden MD FRCPC
St. Clare’s Mercy Hospital
St. John’s, NL
Telephone 709-777-5657
 
For the complete guideline on this topic or for access to any of our guidelines, please visit our Cancer Care Program website

Literature Support:
  • Warner E, Plewes DB, et al. Surveillance of BRCA1 and BRCA2 mutation carriers with magnetic resonance imaging, ultrasound, mammography, and clinical breast examination. JAMA. 2004;292(11):1317-1325.
  • Riedl CC, Ponhold L, et al. Magnetic resonance imaging of the breast improves detection of invasive cancer, preinvasive cancer, and premalignant lesions during surveillance of women for high risk for breast cancer. Clin Cancer Research. 2007;13(20):6144-6152.
  • Lehman CD, Blume JD, et al. Screening women at high risk for breast cancer with mammography and magnetic resonance imaging. Cancer. 2005;103(9):1898-1905.
  • Lord SJ, Lei W, et al. A systematic review of the effectiveness of magnetic resonance imaging (MRI) as an addition to mammography and ultrasound in screening young women at high risk of breast cancer. Eur J Cancer. 2007;43(13):1905-1917.
  • Kriege M, Brekelmans CTM, et al. Efficacy of MRI and mammography for breast-cancer screening in women with a familial or genetic predisposition. N Engl J Med. 2004;351(5):427-437.
  • Lee L, Pintilie M, et al. Screening mammography for young women treated with supradiaphragmatic radiation for Hodgkin’s lymphoma. Ann Oncol. 2008;19(1):62-67.
  • Kaiser WA, Zeitler E, et al. MR imaging of the breast: Fast imaging sequences with and without Gd-DTPA. Radiology. 1989;170(3):681-686.
  • Alberta Health Services. Magnetic resonance imaging for breast cancer screening, pre-operative assessment, and follow-up. 2010. www.albertahealthservices.ca
  • Hwang ES, Kinkel K, et al. Magnetic resonance imaging in patients diagnosed with ductal carcinoma-in-situ: Value in the diagnosis of residual disease, occult invasion, and multicentricity. Annals of Surgical Oncology. 2003;10(4):381-388.
  • Frei KA, Kinkel K, et al. MR imaging of the breast in patients with positive margins after lumpectomy: Influence of the time interval between lumpectomy and MR imaging. Amer J Roentgenology. 2000;175(6):1577-1584.
  • Lee JM, Orel SG, et al. MRI before reexcision surgery in patients with breast cancer. Amer J Roentgenology. 2004;182(2):473-480.
  • Heywang-Köbrunner SH, Schlegel A, et al. Contrast-enhanced MRI of the breast after limited surgery and radiation therapy. J Comput Assist Tomogr.1993;17(6):891-900.
  • Soderstrom CE, Harms SE, et al. Detection with MR imaging of residual tumor in the breast soon after surgery. Amer J Roentgenology. 1997;168(2):485-488.
  • Olson JA, Morris EA, et al. Magnetic resonance imaging facilitates breast conservation for occult breast cancer. Annals Surg Oncol. 2000; 7(6):411-415.
  • Schorn C, Fischer U, et al. MRI of the breast in patients with metastatic disease of unknown primary. Eur Radiol. 1999;9(3):470-473.
  • Henry-Tillman RS, Harms SE, et al. Role of breast magnetic resonance imaging in determining breast as a source of unknown metastatic lymphadenopathy. The Amer J Surgery. 1999;178(6):496-499.
  • Bhattacharyya M, Ryan D, et al. Using mri to plan breast-conserving surgery following neoadjuvant chemotherapy for early breast cancer. British J Cancer. 2008;98(2):289-293.
  • Chen JH, Feig B, et al. MRI evaluation of pathologically complete response and residual tumors in breast cancer after neoadjuvant chemotherapy. Cancer. 2008;112(1):17-26.
  • Rosenkrantz Hölmich L, Fryzek JP, et al. The diagnosis of silicone breast-implant rupture: Clinical findings compared with findings at magnetic resonance imaging. Annals Plastic Surg. 2005;54(6):583-589.
  • Herborn CU, Marincek B, et al. Breast augmentation and reconstructive surgery: MR imaging of implant rupture and malignancy. Eur Radiol. 2002;12(9):2198-2206.
  • Delille JP, Slanetz PJ, et al. Physiologic changes in breast magnetic resonance imaging during the menstrual cycle: Perfusion imaging, signal enhancement, and influence of the T1 relaxation time of breast tissue. The Breast Journal.2005;11(4):236-241.

 

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Updated Apr 4, 2014