Description of Treatment/Procedure:

Breast cancer is the most common type of cancer among women in the industrialized world. Magnetic resonance imaging (MRI) is emerging as a clinically useful examination for detection, diagnosis, and/or monitoring of breast abnormalities. The technique of MRI detection of breast cancer is based on the propensity of breast carcinomas to enhance after intravenous administration of gadolinium-based contrast medium.

Committee Summary

With regard to MRI for the detection of breast abnormalities, the ICSI Technology Assessment Committee finds:

1. MRI as a screening test for the low-risk general population has not been studied and should not be performed at this time. Mammography and ultrasound should be used for the initial evaluation of breast symptoms.
   
2. Reported sensitivities of MRI for detecting invasive breast cancer ranged from 93%-100% and specificities ranged from 37%-96% (Conclusion Grade II). Sensitivities of MRI for detecting ductal carcinoma in situ (DCIS) ranged from 45%-100%.
   
3. Based on 2 studies, breast MRI has been shown to accurately estimate residual disease in 97%-100% of patients after induction chemotherapy prior to surgery (Conclusion Grade III).
   
4. MRI screening of high-risk patients (previous personal or strong family history of breast cancer or carriers of a breast cancer susceptibility gene) is currently being studied in several multicenter studies.
   
5. Reported sensitivities of MRI for evaluation of silicone breast implant rupture ranged from 78%-87% and specificities ranged from 76%-91%.
   
6. MRI is helpful in ruling out invasive cancer in many problem-solving situations. Negative predictive values have ranged from 96%-100%. However, MRI should not be used to avoid further evaluation of a suspicious lesion seen mammographically or sonographically.
   
7. In the absence of contraindications, MRI is a safe procedure. Patients should be aware of possible false-positive and false-negative findings which have ranged from 4%-63% and 0%-55%, respectively, depending on the indication.
   
8. Facilities offering MRI for breast cancer evaluation must also have a breast center where further assessment with diagnostic equipment (including biopsy) can be done.