Patterns of Breast Magnetic Resonance Imaging Use

Abstract

Both theAmericanCancerSociety1and theNationalComprehensiveCancerNetwork2havepublishedguidelinesonthe recommended use of breast magnetic resonance imaging (MRI). In both sets of guidelines, lifetime breast cancer risk greater than 20%has been established as an acceptable threshold for annualMRI screeningwhenused togetherwith annualmammography screening. Routine breast MRI screening is not recommended for a new cancer diagnosis or for cancer surveillance. Nevertheless,MRI remains frequentlyused for theseother indications. A systematic review of the accuracy of MRI and its impact on surgical treatment of breast cancer showed that the use of MRI for treatment planning is widespread, although its benefit remains difficult todemonstrate.3 For evaluation of the contralateral breast in patients with a new diagnosis of breast cancer, the American College of Radiology Imaging Network (ACRIN) 6667 trial found that the contralateral breast cancer detection rate with breast MRI was 3.1%, indicating possible utility in this setting.4Recent studieshavealso indicatedvalue forbreastMRI inneoadjuvant treatmentwherebreastMRImay have clinical utility both in treatment planning and as a prognosticmarker.5 As yet, however, the impact ofMRI on clinical management has not been linked to improvements in breast cancer outcomes.