I hear a lot about breast MRI. Who should have one?

These guidelines have been established to assist clinicians in the ordering of breast MRIs.  The field of breast MR imaging is rapidly expanding and changing.  Therefore, these guidelines are not meant to be all-inclusive, but rather to give a concise overview of the most common reasons to order this exam

RECOMMENDED

1. Known Breast Cancer

• Pre-surgical evaluation of patients with newly diagnosed breast cancer.
• To detect mammographically-occult breast cancer in patients with known auxiliary metastases of breast origin.
• Pre-surgical planning to assess patient eligibility for breast-conserving therapy after neoadjuvant chemotherapy.  MRI performed before and after chemotherapy.
• Evaluation of patients with known nipple malignancy (Paget Disease) and negative mammogram.
• Post-surgical evaluation with positive surgical margins if an MRI was NOT performed pre-operatively.

2. Breast Cancer Screening (Yearly, alternating with mammography at six month intervals)

• Very high genetic risk (BRCA 1 or 2; other significant family history)
• Greater than 20% lifetime risk
• Women who have received chest mantle radiation between the ages of 10 and 30 years of age, beginning 10 years after chest radiation

3. Evaluation of silicone implants in the case of suspected rupture (NOTE: THIS EXAM IS DONE WITHOUT CONTRAST AND IS NOT APPROPRIATE FOR BREAST CANCER EVALUATION/ SCREENING)

OTHER SITUATIONS FOR WHICH MRI MAY BE CONSIDERED

1. Bloody nipple discharge, nipple retraction, skin dimpling or other suspicious clinical changes in the breast if conventional imaging fails to find a cause
2. In patients with a history of treated breast cancer (factors to consider include history of mammographically-occult cancer, premenopausal status, dense breasts, etc.)
3. Screening in patients with a history of atypical lobular hyperplasia (ALH) or lobular carcinoma in situ (LCIS) with a family history of a first degree relative with breast cancer as part of a comprehensive breast cancer risk assessment
4. To assess response to neoadjuvant chemotherapy to guide therapeutic decision-making
5. To determine the extent of chest wall invasion in patients with posteriorly-located tumors
6. Characteristics limiting evaluation with mammography (i.e. very dense breasts, implants, scarring, etc.) when conventional imaging does not answer clinical question

NOT USUALLY RECOMMENDED

1. To assess lesions recommended for short-term follow-up or biopsy based on conventional imaging which would otherwise be followed up or biopsied
2. Pre-operative evaluation of patients with localized breast cancer if cancer is felt to be adequately evaluated with mammography (i.e. fatty breasts).
3. Routine screening in asymptomatic, average risk population.