In the Clinic

On Cancer: MRI Use in Breast Cancer

By Jim Stallard, MA, Writer/Editor  |  Monday, November 21, 2011
Pictured: Monica Morrow Breast Surgical Service Chief Monica Morrow

Research published in the November 19 issue of The Lancet finds that MRI use for breast cancer screening in women at high risk for the disease – due to family history or a genetic mutation – detects more cancers than screening mammography. The review article also reports that cancers detected by MRI are smaller and less likely to have lymph node involvement than those detected by mammography. These findings provide strong evidence that MRI can benefit this high-risk group. [Read PubMed abstract.]

However, despite MRI being better than mammography at detecting tumors, MRI did not lead to improved outcomes for most women with breast cancer who underwent imaging prior to selecting a treatment.

Memorial Sloan Kettering Breast Surgical Service Chief Monica Morrow, lead author of the article, writes that MRI has become widely used to evaluate newly diagnosed breast cancer patients. The expectation had been that MRI’s higher sensitivity for detecting tumors would benefit patients by more accurately identifying the extent of cancer in the breast.

This would presumably lead to better surgical choices for removing the cancer, reducing the number of operations required, and possibly lowering the risk of the disease recurring. However, a review of patient outcome data from multiple studies found no evidence of such benefits.

“Our study differs from others in that we specifically asked whether MRI findings changed these outcomes for patients,” Dr. Morrow says. “There is no doubt that MRI finds some cancer that is undetected with other imaging methods, but in most patients this has not been shown to help when choosing a type of surgery.”

Evidence suggests MRI is still beneficial for specific groups of breast cancer patients, such as those receiving chemotherapy before surgery and those who have cancer in the lymph nodes without an identifiable breast tumor.

Dr. Morrow adds that the true value of MRI use in breast cancer patients may ultimately lie in its ability to assess how well a specific case of breast cancer is responding to a particular drug treatment, although this needs to be validated by large studies.

Comments

Dr. Morrow:
I have been followed mammographically every 6 months for 81/2 years. In 2010 I had a surgical biopsy for suspicious microcalcifications on my left breast which turned out to be benign. However my right breast remained suspicious and was xrayed every 6 months. just when they thought I was reaching the 2 year benchmark of stabalization, the January 2013 mammogram showed cell changes. This resulted in having a stereotactic core biopsy which showed DCIS, a lesion of 3cm, no necrosis, grades 1&2, estrogen and progesterone positive. My thoughts have been to have a lumpectomy followed by radiation but the size of the lesion was of concern. I embarked on a lot of researdh to help me make an informed decision. I read that Dr. Melvin Silverstein does an MRI prior to planning surgery. I therefore Insisted on an MRI which I had on 3/6/13. The results of the MRI showed the disease to be twice as large , 6mm, as initially determined. If I had the surgery based on the initial results, 3cm, only 1/2 of the disease would have been excised. A MRI core biopsy showed the disease to again be DCIS low grade, All my tests have been performed at the William Beaumont Hospital, Royal Oak, MI, in the metro Detroit area. I sent my slides and images to Dr. Michael Lagios for a second opinion. Dr. Lagios concurred with Beaumont and graded my disease as low grade, no necrosis but with a VNPI index of 7-8. The MRI proved to be of value in my case.discovering more disease. However I am now agonizing as to which treatment to pursue, lumpectomy or mastectomy, I weigh 100lb and my breast size is considered small. I've read that you and Dr. Schnitt are involved in a study to redefine clear margin size in lumpectomy surgeries. I discussed this study with Dr. Lagios. With a disease the size as mine and my small breasts I don't know if a desireable cosmetic outcome is achieveable. I would like to speak with you as well as with Dr. El Tamer before making my final decision . Dr. Lagios is also of the opinion as I believe Dr. Tamer is that with non invasive, low grade DCIS, a sentinel node biopsy may not be necessary. I don't know if I am running out of time for scheduling my surgery.
Sincerely'
Irene M. McDonald

Thank you for your comment Irene. If you would like to make an appointment with a doctor at Memorial Sloan-Kettering, please call 800-525-2225.

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