Kontrastmittel-MRT der Brust bei Staging und Früherkennung: Wo benötigen wir sie?

Abstract

PURPOSE: When imaging is used for screening or preoperative staging, a considerable number of diagnoses show normal breasts or breast tissue. Thus, in contrast to other indications, a high specificity of the methods employed is required in addition to a good sensitivity. Ample data is available for both indications and is analyzed here. MATERIAL AND METHODS: A search of the Pubmed und Cochrane libraries was performed. Original work, systematic reviews, meta-analyses, national and international recommendations and guidelines were considered. RESULTS: Contrast-enhanced breast MRI proved to be the most sensitive method for high risk patients. However, false positive findings leading to “short-term” (4-6 months) follow-up recommendations or to histopathological assessment may occur in 15-20 % of cases, and MR-guided histopathological assessment and, in particular, MR-guided percutaneous biopsy, constitute a bottleneck. The most important advantage of intensified screening programs using MRI is the earlier detection of malignancy, even though evidence from randomized studies is lacking. For preoperative staging no evidence exists to date for an improved outcome, as measured by a decreased number of re-excisions, a decreased rate of recurrences, or improved survival. However, more aggressive treatment has been documented after preoperative MRI. Therefore updated guidelines have not recommended using MRI for preoperative staging in general, but only recommend it for certain subgroups. CONCLUSION: MRI can be recommended as an additional imaging method for the screening of high risk women. However, good quality control and appropriate patient information is necessary. Preoperative MRI is only recommended for selected subgroups. More research is needed before further recommendations can be given.