Breast Screening by MRI

Abstract

Conventional imaging modalities as mammography and ultrasound remain the method of choice for routine screening programs and is the 1st imaging aid, but conventional assessment have well-known limitations, such as inaccurate differentiation between benign and malignant lesions and estimation of the size of malignant tumors. Screening with annual MRI combined with mammography has the potential to be effectively implemented into an organized breast screening program for women at high risk for breast cancer. This is due to the high negative predictive value of the breast MRI which is 99.8%. Also the sensitivity of breast MRI for the detection of cancer is the greatest of all imaging techniques and when the findings of conventional imaging are inconclusive (i.e. BI-RADS 0), MRI can be used as a problem-solving modality, it is also better at identifying the true extent of cancer when multifocal disease or ductal carcinoma in situ is present. MRI sensitivity for DCIS detection increases from 80% for low grade to 98% for high grade. So we need to embrace breast MRI screening, and offer it to our patients who are currently eligible as it is inarguably the best available screening test. Generally speaking breast MRI is highly effective in detection and characterization of occult breast lesions in high risk population, with excellent sensitivity and high specificity. This is attributed to the advance in equipment, technique, development and implementation of interpretation guidelines and development of functional MRI tools which contributed to the improving validity of this modality. Also the superiority of MRI compared to mammography, which is more evident in high risk population, supports the use of MRI as an important tool in screening of asymptomatic high risk women.