Pre-Treatment Breast MRI: Clinical Indications, Outcomes, and Future Directions

Breast MRI is the most sensitive modality for assessing the extent of disease in patients with newly-diagnosed breast cancer because it identifies clinically- and mammographically-occult breast cancers. Though highly sensitive, breast MRI has lower specificity that may result in false positive findings and potential overestimation of disease if additional MRI findings are not biopsied prior to surgery. It had been anticipated that the superior cancer detection rate of pre-treatment MRI would translate to improved immediate (surgical re-excision) and long-term patient outcomes such as breast cancer recurrence and survival rates, but studies have not necessarily supported this assumption. In this review, current recommendations and utilization of breast MRI for pre-treatment local staging of breast cancer will be presented, with an emphasis on specific clinical scenarios for patient selection and its impact on short- and long-term patient clinical outcomes. We will also present new evidence that pre-treatment MRI may support de-escalation of treatment and discuss emerging advanced MRI techniques that may improve diagnostic performance.