Contrast-enhanced breast magnetic resonance imaging: the surgical perspective

BackgroundContrast-enhanced breast magnetic resonance imaging (MRI) has shown excellent sensitivity (93%) for breast malignancies. The clinical role and value of MRI for the breast surgeon remains unresolved and controversial.MethodsA retrospective review of clinical and imaging records was undertaken for 79 surgical patients evaluated by MRI as part of their initial assessment.ResultsOf 79 patients, 71 (90%) had dense mammograms, 64 (81%) had known primary breast cancer (BrCA), 42 (53%) had a family history of BrCA, and 8 (10%) had known breast atypia. MRI identified a larger than clinically suspected BrCA size in 10 (16%) patients and greater BrCA extent in 26 (41%) patients. Of 15 non-BrCA patients, 10 (67%) had a biopsy after the MRI with identification of BrCA in 6 (40%) patients. Overall, there were 20 MRI-initiated core biopsies, of which 14 (70%) identified BrCA. Of 70 BrCA patients, 13 (19%) had neoadjuvant chemotherapy, 35 (50%) had breast-conserving surgery, 36 (51%) had total mastectomy, and 14 (22%) had bilateral total mastectomy. MRI had good pathology correlation in 56 of 62 (90%) patients. In patients with known BrCA (by core biopsy), none of the 29 breast-conserving surgery resections undertaken after MRI had a positive margin or required re-excision.ConclusionsMRI is very accurate for BrCA evaluation, both for lesion size and extent. With good collaboration between the radiologist and surgeon, MRI is a powerful 3-dimensional and communication tool for the breast surgeon and the patient.