Follow-up screening with Magnetic Resonance Imaging MRI Breast Cancer

Multifocality and Multicentricity

If specialists find a significant lesion on an initial mammogram, an MRI is often useful to check for multifocality (more than one mass on the same breast) and multicentricity (presense of a mass or lesion on the contralateral breast).

MRI is routinely done as a preoperative staging procedure. Multifocal and multicentric tumors are succesfully detected through magnetic resonance imaging about 80% of the time.

By comparison, a mammogram reveals multifocal and multicentric tumors about 45% of the time, with supplementary ultrasound increasing the sensibility to approximately 63%.

This page still has some great material, and I would still use it. However, I have a newer version with more up-to-date information on MRI screening.

MRI breast cancer

Follow-up of biopsy

Frequently doctors will follow-up a suspicious finding on mammograph with an appropriate biopsy.

If a patient is in the ‘high risk’ due to the discovery of lobular neoplasia or some other atypical celluar appearance, MRI may be useful to reinforce a preliminary diagnosis.

mri breast cancer

Often a patient will present with a negative finding on a mammograph but a positive finding of axillary lymph node metastasis from biopsy samples from that region.

In these cases MRI is used in a kind of ‘reverse‘ investigation to discover the ‘primary‘ tumor in the breast. The success rate for finding these ‘occult‘ primary tumors in this manner is about 75%.

Post Operative use of MRI Breast Cancer

Following surgical treatments, medics will frequently use MRI to check for residual tumors. The physician will often perform the MRI scan within nine days of the initial surgery, but the most accurate readings occur after approximately 38 to 40 days.

One of the challenges in the follow-up of lumpectomy, with or without radiation treatment, is that specialists can often confuse tumors with predictable scar tissue development.

A lumpectomy scar may contain vascularised granulation tissue up to 18 months following surgery. So there is a limited ‘window‘ for accurate MRI investigations during this period.

To avoid this potential confusion, best results occur no later than 5 weeks following the surgery. The success rate of MRI in differentiating scar from tumor recurrence is very high, 90% or more.

Granulated scar tissue tends to be more regular and homogeneous around the surgery site, while cancerous cells tend to divide and spread in a somewhat random fashion. The use of post operative, follow-up MRI has been shown to ‘alter‘ the original https://breast-cancer.ca/8a-treatment/in up to 30% of cases.

Magnetic Resonance imaging following chemotherapy

The usefulnes of magnetic resonance imaging following chemotherapy remains unclear. There is consensus that MRI is useful for monitoring a patient’s response to ongoing chemical therapy.

By visually checking on the progress of the tumor, adjustments can be made to the drug regimen and the optimal timetable for surgical removal can be planned. A magnetic resonance image can clearly indicate the complete failure of the tumors response to chemotherapy if no change is evident.

What MRI can not definitively determine is whether or not there remains some microscopic residual disease at the end of a course of chemotherapy. Histological cellular analysis is the only method that can determine the complete absence of carcinoma.

For further reading, I suggest you visit this page with information about MRI factors, visit this page to read about MRI for breast cancer staging, and visit this page to know about typical uses for MRI in breast cancer screening and diagnosis. They all have fun Q&A quizzes for you as well!

References

Greenstein Orel S. MR Imaging of the Breast, Radiological Clinics of North America, Vol. 38, No 4, July 2000, p.899-913.
Hlawatsch A, Teifke A, Schmidt M, Thelen M. Preoperative Assessment of Breast Cancer: Sonography Versus MR Imaging. AJR 2002; 179:1493-1501.
Liberman L, Morris EA, Kim CM, Kaplan JB, Abramson AF, Menell JH, Van Zee KJ, Dershaw DD. MR Imaging Findings in the Contralateral Breast of Women with Recently Diagnosed Breast Cancer. AJR 2003; 180:333-341.
Orel SG, Schnall MD. MR imaging of the breast for the detection, diagnosis, and staging of the breast cancer. Radiology 2001; 220:13-30.
Lee CH. Breast MRI: patient selection/Indication. Society of Breast Imaging, 7th Postgraduate Course, 2005; May 25-28, 45-51 Vancouver, BC, Canada.
Partridge SC, Gibbs JE, Lu Y, et al. Accuracy of MR imaging for revealing residual breast cancer in patients who have undergone neoadjuvant chemotherapy. AJR 2002; 179:1193-209.
Sardanelli F, Giuseppetti GM, Panizza P, Bazzocchi M, Fausto A, Simonetti G, Lattanzio V, Del Maschio A; Italian Trial for Breast MR in Multifocal/Multicentric Cancer. Sensitivity of MRI versus mammography for detecting foci of multifocal, multicentric breast cancer in Fatty and dense breasts using the whole-breast pathologic examination as a gold standard. AJR Am J Roentgenol. (Oct. 2004) 183(4):1149-57.
Swayampakula, AN., Dillw, S., Abraham, J.Role of MRI in Screening, Diagnosis and Management of Breast Cancer Expert Rev Anticancer Ther. 2008;8(5):811-817
Esserman LJ, Kumar AS, Herrera AF et al. Magnetic resonance imaging captures the biology of ductal carcinoma in situ. J. Clin. Oncol.(2006) 24, 4603-4610

More References

Buchanan CL, Morris EA, Dorn PL, Borgen PI, Van Zee KJ. Utility of breast magnetic resonance imaging in patients with occult primary breast cancer. Ann. Surg. Oncol. (2005) 12, 1045-1053
Fischer U, Zachariae O, Baum F, von HD, Funke M, Liersch T. The influence of preoperative MRI of the breasts on recurrence rate in patients with breast cancer 1497. Eur Radiol. (2004);14:1725–1731.
Hwang ES, Kinkel K, Esserman LJ, Lu Y, Weidner N, Hylton NM. Magnetic resonance imaging in patients diagnosed with ductal carcinoma-in-situ: value in the diagnosis of residual disease, occult invasion, and multicentricity. Ann Surg Oncol. 2003;10:381–388.
Peters NH, Borel Rinkes IH, Zuithoff NP, Mali WP, Moons KG, Peeters PH. Meta-analysis of MR imaging in the diagnosis of breast lesions. Radiology.( 2008);246:116–24.
Lee JM, Orel SG, Czerniecki BJ, Solin LJ, Schnall MD. MRI before reexcision surgery in patients with breast cancer. AJR Am J Roentgenol.(Feb.2004) 182(2):473-80.
Hylton, N. MR imaging for assessment of breast cancer response to neoadjuvant chemotherapy. Magn Reson Imaging Clin N Am (2006); 14:383.
Esserman, L, Hylton, N, George, T, Weidner, N. Contrast-Enhanced Magnetic Resonance Imaging to Assess Tumor Histopathology and Angiogenesis in Breast Carcinoma. Breast J (1999); 5:13.
Zakhireh, J, Gomez, R, Esserman, L. Converting evidence to practice: a guide for the clinical application of MRI for the screening and management of breast cancer. Eur J Cancer (2008); 44:2742.

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