Role of MRI in Breast Cancer

Angela KongPrincess Margaret Hospital

Introduction

Role of MRI breast cancer screening preoperative newly diagnosed breast

cancer Response after Neoadjuvant

chemotherapy

Summary/ Conclusion

Objective

MRI breast – increasingly popular breast imaging

Contrast agent: Gandolinium

Typical rapid enhancement and washout of contrast

Introduction

Guidelines of major groups recommend annual screening of selected patients with mammography and breast MRI BRCA mutation carriers Untested first-degree relatives of

BRCA mutation carriers Lifetime risk of Ca breast >20-25%

National Comprehensive Cancer Network (NCCN)/ACG guidelines

American Cancer Society Guidelines

American College of Radiology Recommendations

MRI in breast cancer screening

MRI has a higher sensitivity than MMG in BRCA mutations

Sensitivity in MMG is lower in young patients with dense breast tissue

BRCA associated breast tumours have distinct histology

“benign” features on MMG/USG

MRI in breast cancer screening

Mass with a pushing margin

Mass with a spiculated border

Can MRI screening in high risk group improve their outcome?

MRI in breast cancer screening

No significant difference between MRI and MMG screened group

MRI significant has survival benefit compared to non screened group (P<0.002)

MRI breast screening in high-risk women: cancer detection and survival analysis. Breast Cancer Res Treat.

2014 Jun

MRI screened MMG screened

No screening

10 year survival

95.3% 87.7% 73%

Key Message:

MRI screening is indicated in high risks population due to higher sensitivity

Long term survival benefit was

unclear

Preoperative staging with MRI

Preoperative staging with MRI

Year Study design

n MRI group

Non MRI group

P value

COMICE 2010 RCT 1625 19% 19% 0.77

MONET 2011 RCT 418 34% 12% 0.008

Houssami

2013 Meta-analysis

3112 11.6% 11.4% 0.87

Preoperative MRI on short term outcome

Evidence on MRI effect on surgical re-excision rate

NO significance difference in terms of the rate of re-excision

One study showed paradoxically MRI had increased the re-excision rate

Year Study design

n MRI group

Non MRI group

P value

MONET 2011 RCT 418 11% 14% o.49

Houssami

2013 Meta-analysis

3112 25.5% 18.2 0.001

Preoperative MRI on short term outcome

Evidence on MRI effect on overall mastectomy rate

One study showed increase in mastectomy rate

Key message:

MRI does not reduce the re-excision rate

Potential increase in mastectomy rate without lowering the local recurrence and improving survival

Routine use is not recommended

MRI following neoadjuvant therapy

Monitor of response: Clinical exam MMG USG ? MRI

MRI following neoadjuvant therapy

MRI has improved accuracy than MMG Can accurately detects residual tumour or

complete pathology response

Meta-Analysis of Magnetic Resonance Imaging in Detecting Residual Breast Cancer After Neoadjuvant Therapy. J Natl Cancer Inst. 2013 Mar 6;105(5):321-33

MRI following neoadjuvant therapy

No. of studies

Diagnostic odd ratio

P value

MRI VS clinical

11 0.53 0.1

MRI VS USG 10 0.54 0.15

MRI VS MMG 7 0.27 0.02

Key message:

MRI is helpful to monitor treatment response after chemotherapy

No evidence on effect on surgical management

MRI following neoadjuvant therapy

MRI breast is recommended: High risk group as screening Breast cancer patients who undergo

neoadjuvant chemotherapy

Routine use not indicated

More evidence needed to assess long term outcome

Conclusion

Thank you