Feature | July 18, 2011 | Helen Kuhl

Breast MRI Finds Its Place

This article appeared as the introduction to the breast MRI comparison chart.

Although mammography retains its place as the first-line modality for regular screening for breast cancer, breast magnetic resonance imaging (MRI) has a firm spot as a valuable complementary tool. An official nod came in 2007, when the American Cancer Society updated its guidelines and recommended that women at high risk for developing breast cancer should get yearly breast MRIs along with their mammograms.

At the time of American College of Radiology’s (ACR) previous update in 2002-03, it did not feel there was enough evidence to recommend for or against MRI in high-risk women. But by 2007, it believed there was more solid evidence. [1] ACR continues to say that women with moderate risk should consult with their doctors regarding the need for an MRI, and it does not recommend screening MRIs for women with a low lifetime risk (below 15 percent). Also, screening MRIs are not recommended alone, but in addition to a screening mammogram.

For women at high-risk, the recommendation is that screening with mammograms and MRIs begin at the age of 30. It is often more practical for a woman to get a screening MRI at a facility that also can do an MRI-guided breast biopsy at the same time, if it is needed.

Breast MRIs also were found to be useful for finding tumors in the opposite breast in women who are newly diagnosed with the disease, according to a study done by researchers at the University of Washington Medical Center in Seattle and published in 2007. The study was done to determine whether MRIs can find contralateral cancers that mammograms and physical exams miss. Among the 969 newly diagnosed breast cancer patients in the study, the MRIs found 30 early-stage tumors that were not detected in mammograms or physical exams, missing just three. [2]

Pluses and Minuses
Contrast-enhanced MRI can be useful in the detection of breast cancer because it is considered to be more sensitive than mammography or ultrasound, with sensitivity ranked higher than 95 percent. It produces detailed images of the soft tissues and is generally considered to be helpful for women with dense breast tissue, in addition to those classified as high-risk.

The main disadvantage to breast MRI has been its relatively low specificity. It produces more false-positive results than mammography, which can lead to unnecessary biopsies that cause anxiety for the patient, as well as increased costs.

However, a recent study published in Radiology [3] found that repeat MRI screening for breast cancer resulted in fewer false-positives. The study was conducted to determine whether the availability of prior MR images for comparison reduces the rate of false-positives associated with the initial MRI breast screening exam. It found that the rate of false-positives was significantly higher in a baseline group consisting of patients’ first screening exams than those having annual or repeat screening MRIs.

“False-positives are a risk of the breast MRI procedure, but the rate decreases following the initial round of screening,” said the study’s co-author, Martha B. Mainiero, M.D., director of the Anne C. Pappas Center for Breast Imaging at Rhode Island Hospital and associate professor of diagnostic imaging at the Warren Alpert Medical School of Brown University in Providence, R.I. “This information should provide reassurance for high-risk patients who are considering undergoing  annual MRI screening exams.”

Currently, Aurora Imaging Technology is the only company with a commercially available, U.S. Food and Drug Administration (FDA)-cleared MRI system designed specifically for 3-D bilateral breast imaging. However, several vendors offer MRI systems with dedicated breast coils. The coils are designed to transform an MRI scanner into a dedicated system for breast MR imaging and intervention.  

References:
1. “ACS Advises MRIs for Some at High Risk of Breast Cancer,” March 28, 2007; www.cancer.org
2. “MRI Valuation of the Contralateral Breast in Women with Recently Diagnosed Breast Cancer,” March 29, 2007; New England Journal of Medicine, Vol. 356, No. 13: 1295-1303.
3. “Screening Breast MR Imaging: Comparison of Interpretation of Baseline and Annual Follow-up Studies,” Gil Abramovici and Martha B. Mainiero, Radiology, April 2011, 259:85-91; published online Feb. 1, 2011, doi:10.1148/radiol.10101009

Related Content

Videos | Breast Density | April 26, 2018
ITN Editorial Director Melinda Taschetta-Millane speaks to DenseBreast-info Executive Director JoAnn Pushkin
ACR/SBI Breast Cancer Screening Guidelines Reclassify African-American Women as High-Risk
News | Breast Imaging | April 06, 2018
New American College of Radiology (ACR) and Society of Breast Imaging (SBI) breast cancer screening guidelines are the...
ACR Recommends More Aggressive Breast Cancer Screening for Higher-Than-Average-Risk Women
News | Breast Imaging | March 29, 2018
The American College of Radiology (ACR) released new breast cancer screening guidelines recommending all women,...
Videos | Breast Imaging | December 05, 2017
Stamatia Destounis, M.D., FACR, associate professor, University of Rochester School of Medicine, attending radiologis
Study Finds Women With High Breast Cancer Risk Declining MRI Screening
News | MRI Breast | October 31, 2017
Some women, because of genetic predisposition, personal or family history, have a higher than average lifetime risk of...
Videos | Breast Imaging | July 28, 2017
Nancy Cappello, Ph.D., executive director and founder of Are You Dense Inc. and Are You Dense Advocacy, explains how
MRI Plus Mammography Improves Detection of New Breast Cancer After Surgery
News | Breast Imaging | June 22, 2017
A new article published by JAMA Oncology compares outcomes for combined mammography and magnetic resonance imaging (MRI...
Radiology journal, breast MRI screening, average risk women, breast cancer

Images in a 55-year-old screening participant. (a, b) Normal digital full-field mediolateral oblique (a) and craniocaudal (b) mammograms (BI-RADS category 1) show a heterogeneously dense breast (ACR category C). (c) Screening ultrasound image shows normal findings (BI-RADS category 1). (d) MR-guided biopsy enabled us to confirm the presence of an invasive high-grade triple-negative cancer (no special type [NST], pT1b, N0, M0). (d) Breast MR image shows a suspicious enhancing mass (arrow) in the left breast (BI-RADS category 5). Image courtesy of the Radiological Society of North America.

News | MRI Breast | February 21, 2017
Magnetic resonance imaging (MRI) screening improves early diagnosis of breast cancer in all women, not only those at...
Rapid Breast MRI, breast cancer screening, David Strahle, RMI, Breast Cancer Research and Treatment study
News | MRI Breast | February 10, 2017
February 10, 2017 — A new method for screening women with dense...