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This Article Full Text CME: Take the course for this article: Preoperative Magnetic Resonance Imaging (MRI) in Breast Cancer: Should MRI ... FREE NURSING CONTACT HOURS All Versions of this Article: caac.20028v1 59/5/290    most recent Submit a letter to the editor View responses Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Houssami, N. Articles by Hayes, D. F. Search for Related Content PubMed PubMed Citation Articles by Houssami, N. Articles by Hayes, D. F.

Review of Preoperative Magnetic Resonance Imaging (MRI) in Breast Cancer: Should MRI Be Performed on All Women with Newly Diagnosed, Early Stage Breast Cancer?

¹Associate Professor and Principal Research Fellow, Screening and Test Evaluation Program (STEP), School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia, and Breast Physician at the Royal Hospital for Women, Sydney, Australia
²Clinical Director of the Breast Oncology Program, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan

Corresponding author: Nehmat Houssami, MBBS, PhD, Screening and Test Evaluation Program (STEP), School of Public Health, Edward Ford Building (A27), University of Sydney, NSW 2006, Australia; nehmath{at}med.usyd.edu.au

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DISCLOSURES: Nehmat Houssami is funded by National Health and Medical Research Council program grant no. 402764 to the Screening and Test Evaluation Program. Daniel F. Hayes is supported by the Fashion Footwear Charitable Foundation of New York/QVC Presents Shoes on Sale. No other potential conflict of interest relevant to this article was reported.

Randomized controlled trials have shown equivalent survival for women with early stage breast cancer who are treated with breast-conservation therapy (local excision and radiotherapy) or mastectomy. Decades of experience have demonstrated that breast-conservation therapy provides excellent local control based on defined standards of care. Magnetic resonance imaging (MRI) has been introduced in preoperative staging of the affected breast in women with newly diagnosed breast cancer because it detects additional foci of cancer that are occult on conventional imaging. The median incremental (additional) detection for MRI has been estimated as 16% in meta-analysis. In the absence of consensus on the role of preoperative MRI, we review data on its detection capability and its impact on treatment. We outline that the assumptions behind the adoption of MRI, namely that it will improve surgical planning and will lead to a reduction in re-excision surgery and in local recurrences, have not been substantiated by trials. Evidence consistently shows that MRI changes surgical management, usually from breast conservation to more radical surgery; however, there is no evidence that it improves surgical care or prognosis. Emerging data indicate that MRI does not reduce re-excision rates and that it causes false positives in terms of detection and unnecessary surgery; overall there is little high-quality evidence at present to support the routine use of preoperative MRI. Randomized controlled trials are needed to establish the clinical, psychosocial, and long-term effects of MRI and to show a related change in treatment from standard care in women newly affected by breast cancer. CA Cancer J Clin 2009. © 2009 American Cancer Society, Inc..

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