Multiple factors drive increased use of preop MRI
Breast cancer patients should understand pros & cons
There is no question that the use of MRI prior to breast cancer surgery has increased dramatically in recent years. At the Mayo Clinic in Rochester, MN, for example, the use of preoperative MRI in breast cancer patients more than doubled between 2003 and 2006.
What is behind this increase? Scientific data, for one, but there are other factors driving this utilization, according to Amy Degnim, MD, a breast surgeon at the Mayo Clinic who has conducted a study on the use of MRI.
"It is a very sensitive technology, and it is able to show us many lesions in the breast, and women as well as providers who are dealing with breast cancer want the most assurance they can have that they are going to get all the disease out and provide the patient with the best long-term outcome," she says. However, Degnim adds there is also a tendency to want to use the latest and greatest technology. "The utilization of [MRI] has grown faster than the scientific community's ability to prove how it impacts outcomes."
But that is not to say that there isn't some data. Most radiologists rely on a study by Constance Lehman, MD, PhD, a diagnostic radiology specialist at the Fred Hutchinson Cancer Research Center at the University of Seattle, showing that MRI evaluation of the breast can detect cancer that is missed by mammography and ultrasound.1 Consequently, Degnim points out that there is a clear indication for the use of MRI in patients who have breast cancer in the axillary lymph nodes, but the primary cancer has not been detected by mammography or ultrasound. "This is a case where absolutely MRI is helpful because it is going to show you a primary [cancer] where other standard procedures show you nothing," she says.
There are pros and cons
However, beyond that very restrictive group, there are few clear-cut answers. Christopher Comstock, MD, an associate clinical professor and the director of breast imaging at University of California, San Diego's Department of Radiology, thinks it is helpful to have an MRI prior to breast surgery for most of his patients. However, Comstock believes it is particularly helpful in more complicated cases such as in younger women, women with extremely dense breast patterns where the cancer is difficult to detect mammographically, and in women with invasive lobular cancers, for example.
Similarly, Degnim believes that MRI should be offered to all newly diagnosed patients, but with a thorough discussion of the pros and cons of undergoing the procedure and the limitations of the scientific evidence. "We talk about the risk of false positives and the potential likelihood that there might be an increased risk of them going on to a mastectomy if they undergo an MRI, but it is interesting in practice that there is always a wide variety of responses from people," she says. "Some people say they absolutely want it, and others say they are not interested in that."
Reference
- Lehman C, Gatsonis C, Kuhl C, et al. MRI evaluation of the contralateral breast in women with recently diagnosed breast cancer. New Eng J Med 2007; 356:1,295-1,303.
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