Contrast-enhanced breast magnetic resonance imaging: the surgical perspective

Contrast-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.

A retrospective review of clinical and imaging records was undertaken for 79 surgical patients evaluated by MRI as part of their initial assessment.

Of 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.

MRI 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.