Utility of magnetic resonance imaging (MRI) in the management of breast carcinoma

Background and purpose: Breast MRIs demonstrate the greatest yield as an adjunct to conventional imaging in the screening of high-risk breast cancer patient groups. The aim of this article is to evaluate the screening performance of Breast MRI as a screening technique for breast carcinomas, and future potential imaging modalities in the surgical management of breast carcinoma. Methods: Electronic databases (MEDLINE, EMBASE and the Cochrane Library) were searched for articles published between 2002 and 2022 using Mesh terms "magnetic resonance imaging" and "breast cancer". English articles with available abstracts published in surgical, oncological, and radiological journals were reviewed. Articles that did not address screening, Neoadjuvant Chemotherapy (NACT) response, Ductal carcinoma insitu (DCIS), Invasive lobular carcinoma (ILC), Breast implant associated Anaplastic Large Cell Lymphoma (BIA-ALCL) and Abbreviated-MRI (AB-MRI) or the alternative of Diffuse-weighted imaging (DWI) were excluded. Results: Studies found that Breast MRI demonstrated improved detection rates of breast carcinoma and acted as an adjunct to conventional imaging in the screening of high-risk patient groups (BRCA-positive, history of breast cancer/chest radiation/high-risk lesion) and in the diagnosis of high-grade DCIS (74-92% vs. 35-41% for Mammography).[1] To a lesser extent, breast MRI assists in NACT response monitoring in DCIS with invasive components and hormone-insensitive/HER2-positive, lobular, and large tumours and has enhanced utility in the preoperative work-up of ILC with sensitivities of 95% where BCS is planned.[2] Breast MRI had both underestimated and overestimated residual tumour size. Emerging imaging modalities such as AB-MRI, DWI, and Contrast enhanced mammography (CEM) have near equivocal sensitivities (from 70-100% vs. 86% vs. 98%), thus reducing unnecessary biopsies from being performed. Conclusion: Breast MRI work-up of breast carcinoma possesses superior soft-tissue diagnostic qualities, not replicated by conventional imaging, such as ultrasonography or mammography. Additional imaging modalities such as AB-MRI, DWI and CEM are additional emerging screening tools that overcome the disadvantages associated with breast MRI and have demonstrated preliminary equivocality. References: 1. Mann RM, Cho N, Moy L. Breast MRI: State of the Art. Radiology. 2019; 292(3): 520-36. 2. Amin A.L., et al. Does the addition of Breast MRI add value to the diagnostic workup of invasive lobular carcinoma? Journal of surgical Research. 2021; 257, pp.144-152.