Weird Skin Stuff

July 2009

Clinical

The role of breast MRI in clinical practice

Volume 38, No.7, July 2009 Pages 513-519

Meagan Brennan

Andrew J Spillane

Nehmat Houssami

Background

The use of magnetic resonance imaging (MRI) for breast screening is increasing. Women may approach their general practitioner for advice on its role in breast screening and diagnosis.

Objective/s

This article provides an evidence based update on the role of breast MRI.

Discussion

There is good evidence to support the use of MRI for cancer screening in younger women at high genetic risk of breast cancer. Its use for assessing the extent of disease in the breast after breast cancer is diagnosed (local staging) is controversial. Certainly MRI is more sensitive than conventional imaging for detecting multifocal/ multicentric disease, however, there is evidence that some women have more extensive surgery as a result of MRI without clear evidence of benefit. There is no role for MRI as a substitute for mammography or for screening women at average risk of breast cancer. It also has no routine role as a diagnostic test in women with symptoms.

Over the past 10 years, the use of magnetic resonance imaging (MRI) for screening and diagnosis of breast cancer has been increasing. Uses include screening in women at high genetic risk of breast cancer, evaluating the extent of disease in women with a recent diagnosis of breast cancer, and detecting synchronous contralateral cancer. Magnetic resonance imaging has high overall sensitivity and has at times been promoted as a ‘gold standard’ in breast imaging. However, its role remains controversial. Importantly, breast MRI has a high false positive rate and evidence of benefit in some clinical situations is lacking. There may be a high level of awareness of MRI among some women presenting to specialist clinics with breast symptoms. It is important that practitioners provide evidence based answers to their questions.

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Correspondence afp@racgp.org.au

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