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MRI Breast Indications

Indications: - Staging: Local extent of disease - Residual/recurrent disease - Neoadjuvant chemotherapy - Axillary LN of unknown primary - Problematic mammo including implants - High risk screening Local staging: - MultiFocal: same quadrant, distance between 2 lesions < 5 cm - MultiCentric: different quadrants, distance between 2 lesions > 5 cm - Pectoralis or chest wall involvement - Skin or nipple involvement - Not for exclusion of tumor involvement of axilla: still need sentinel node sampling ACRIN: ACR Imaging Network Mammo MRI has not been shown - to reduce mortality - to reduce local recurrence - to reduce need for re-excision surgery Local extent: MRI Potential use - in cases where pt do not undergo whole-breast XRT (no XRT or partial breast XRT) - identify cases of invasive disease (not only DCIS) - high risk - mammographically occult ca - dense breast at mammo - young age 40-50 yo - lobular histology - Triple neg, HER-2+ - Posterior ca Posterior ca: - Pectoralis is not a part of chest wall - Chest wall: ribs, intercostal and serratus anterior muscles --> upstages to IIIB - Muscle enhancement is sensitive and specific (not necessaryly in contiguity with mass) Skin and nipple involvement: - loc extension vs diffuse dermal lymphatic invasion (inflammatory) - skin thickening > 4 mm segmental (along the duct and segment), non-mass enhancement extending to nipple --------------------------------------------------- Residual/recurrent disease: 1y for residual, longer than 1 y recurrent d - image approx 1 week post-op (vs. 28 d) - need to distinguish residuum from post-op inflammatory change, rim enhancement is post-surgical change - mass like enhancement beyond rim is residuum ----------------------------------------------------- Neoadjuvant chemo response - neoadjuvant is preop chemo to decrease ca before surgery and zap micromets - adjuvant is post op chemo ----------------------------------------------------- Axillary LN of uknown primary - if breast - local regional disease - if lung, or thyroid or ... - mets ----------------------------------------------------- Problematic mammo after complete mammo and sono work-up for one view asymmetry