ARRS 2022 Abstracts

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E1614. How Breast MRI Can Help Tailor Management in Patients with Newly Diagnosed Breast Cancer: A Case-Based Primer
Authors
  1. Nayanatara Swamy; University of Arkansas for Medical Sciences
  2. Rachel Taylor; University of Arkansas for Medical Sciences
  3. Patrick Jennings; University of Arkansas for Medical Sciences
  4. Shweta Srivastava; University of Arkansas for Medical Sciences
  5. Scott Harter; University of Arkansas for Medical Sciences
  6. Gwendolyn Bryant-Smith; University of Arkansas for Medical Sciences
Background
Among the current imaging modalities, breast MRI has the highest sensitivity (> 90% to almost 100%) in detecting breast cancers. Although earlier studies found a wide range of specificity (37–97%), with technological improvement and increased reader experience, its specificity and PPV are also high, 97.1% and 35.7%, respectively. MRI can detect lesions that are mammographically and sonographically occult. It can detect 15.5 additional cancers per 1000 patients, and its use lowers the interval cancer rate. Its superior delineation of tumor morphology and kinetic feature analysis make it a powerful diagnostic tool, with an expanding role as a screening tool in select patient subgroups. In patients with newly diagnosed breast cancer, pre-operative use of breast MRI can identify accurate tumor size, nodal status, additional tumors in the ipsilateral and contralateral breast, and help in guiding the type of surgical management (breast conservation surgery versus mastectomy).

Educational Goals / Teaching Points
The main goal of this presentation is to provide an overview of how MRI can play a role in modifying surgical and oncologic management of breast cancers. To this end, a review of the principles behind breast MRI’s role as a morphological and functional tool is provided. Indications of breast MRI in patients with breast cancer are elaborated. Finally, a case-based overview of how MRI can help tailor management in patients with breast cancer will be shown. This will help breast imagers appreciate the utility and effectiveness of MRI in local staging.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
A meta-analysis of 50 studies found that two-thirds of the additional findings on preoperative MRI were malignant, and this additional disease modified treatment in 20% of the patients. When breast MRI is utilized preoperatively, it can lead to reduced re-excision rates and increased chances for breast conservation surgery. It is effective in evaluating the response of tumors to neoadjuvant chemotherapy. Its use following neoadjuvant chemotherapy can lead to a decrease in the number of axillary dissections due to downstaging of the axilla. Therapeutic chemotherapy agents may be modified based on the findings of the breast MRI. It can reveal unilateral multifocal cancer or contralateral disease, which will help the surgeon modify management.

Conclusion
Understanding the role of MRI in breast cancer management is a necessary foundation, which will lead to improved interpretations of these studies in training and in employment.