An algorithm for the integration of breast magnetic resonance imaging into clinical practice

• Published in: The American journal of surgery Vol. 197; no. 5; pp. 691 - 693
• Main Author: Tan, Mona P., M.B.B.S., F.R.C.S. (Ed.)
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-05-2009; Elsevier Limited
• Subjects: Algorithms; Biopsy; Body image; Breast cancer; Breast Neoplasms - diagnosis; Breast Neoplasms - pathology; Breast Neoplasms - surgery; Breast surgery; Cancer; Chemotherapy; Disease control; Female; Humans; Indication; Integration; Irradiation; Lesions; Magnetic Resonance Imaging; Mammography; Mastectomy; Morbidity; NMR; Nuclear magnetic resonance; Radiation; Sensitivity and Specificity; Sexual behavior; Sexuality; Surgery; Womens health
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2008.11.020

Based on these data sets, which suggest a higher risk of multiple synchronous breast lesions than in Hollingworth's study, caution was already sounded with regards to adopting MRI as a routine part of breast cancer evaluation.8 Most such foci is thought to be controlled by irradiation,8 and perhaps to a certain extent, by chemotherapy, as studies on neoadjuvant treatment appear to suggest.9 Without a prospective randomized trial to elucidate whether MRI would result in a meaningful clinical benefit, Morrow warned that using its findings could take breast surgery back to the 1970s where mastectomy would be performed for a disease that can be controlled with radiation.8 Multicentric disease detected on MRI not visible on conventional imaging was an indication for a mastectomy in Hollingworth's study. Bilateral prophylactic mastectomy has been associated with a subsequent negative effect on body image and sexuality.11 Should women elect to undergo immediate reconstruction, complication rates of 46% have been reported.12 MRI used for preoperative assessment could potentially lead to a chain of events resulting in significant morbidity. [...]omitting MRI may not represent an attitude of “burying one's head in the sand,” as has been suggested,10 but it is rather a measured abstinence, understanding that performing the study could result in a negative impact on surgical and long-term psychosocial outcomes. Breast MRI has N Engl J Med, Vol. 347, 2002, 1233-1241 3 U. Veronesi, N. Cascinelly, L. Mariani, Twenty-year follow-up of a randomised study comparing breast-conserving surgery with radical mastectomy for early breast cancer, N Engl...