Dr. Alexandra Nikita, Consultant Breast Radiologist, Mediterraneo Hospital
Breast MRI is a high-resolution imaging test for the examination of breast structures and is performed in addition to a mammography and breast ultrasound. It is a short, completely painless and harmless diagnostic test, during which the examinee does not receive any radiation.
In which cases is breast MRI indicated?
Breast MRI does not replace a mammography or breast ultrasound but is a complementary tool used in the following cases:
- Screening in women at high risk of developing breast cancer. This includes women with a family history of breast or ovarian cancer (mother or sister who developed breast cancer before the age of 50, or more than one close relatives, including those on the examinee’s father side, with a history of breast or ovarian cancer),
- Women with BRCA1 (Breast Cancer Type 1 susceptibility gene) and BRCA2 (Breast Cancer Type 2 susceptibility gene) mutations and women with a history of chest radiation therapy at the age of 10-30 years old. In any case, your radiologist or breast surgeon will review your family history and determine if a breast magnetic resonance imaging is appropriate for you.
- To further investigate equivocal mammography findings. In rare cases, if a lesion detected on a mammogram cannot be adequately evaluated by MRI-guided localization, tomography, or ultrasound, magnetic resonance imaging is used to determine whether or not a biopsy is necessary,
- To accurately determine the extent of the lesion in specific types of diagnosed cancer and exclude the presence of other foci in the same or the other breast, especially in dense breasts and in cases of young women with breast cancer. Breast MRI also investigates the possible presence of abnormal axillary lymph nodes,
- In cases of a previous breast cancer surgery to investigate possible recurrence or development of new foci in the same or the other breast (method of choice),
- To evaluate the mastectomy area after cancer treatment. Surgery scars and recurrent cancer may present some similarities on a mammogram and breast ultrasound. If a change in the mastectomy scar is detected, either via mammography or physical examination, magnetic resonance imaging can show if it is scar tissue or cancer recurrence,
- To assess the response of the tumor to chemotherapy in cases where preoperative chemotherapy is necessary (neoadjuvant chemotherapy),
- For the evaluation of breast implants and the investigation of their rupture.
How is a breast MRI performed?
The examination is performed on an outpatient basis and lasts about 30′. The examinee is placed in a prone position on the specially designed MRI scanner.
The comfort of the examinee during the whole process is important, because in that way she can remain calm and immobile for as long as necessary in order to complete the examination successfully.
The use of an intravenous contrast media (IV contrast) is necessary to investigate possible malignancy, because without it the examination presents insufficient results. If, however, the breast MRI is performed only to evaluate the breast implants, IV contrast is not required except in cases where inflammation in the area of the implant is investigated.
What are the disadvantages of a breast MRI?
The method has two main disadvantages: The first is the high rate of “false-positive” results, i.e. when the MRI reveals pathological findings that prove to be benign formations or areas of active glandular tissue. This is proven by a negative biopsy. The second disadvantage is the inability of the method to detect breast microcalcifications, suspicious for onset malignancy.