Utility of magnetic resonance imaging in the management of breast cancer: Evidence for improved preoperative staging

Purpose: The staging and treatment for breast cancer are changing; there is an increase in the incidence of ductal carcinoma-in-situ, the use of fine- needle aspiration and stereotactic biopsy for diagnosis, and the use of neo adjuvant chemotherapy. thus, there is a need for a tool to assess more prec isely the extent of cancer in the breast before surgery. to better plan sur gical and chemotherapeutic interventions, we evaluated high-resolution magn etic resonance imaging (MRI) as such a tool. Patients and Methods: Fifty-seven patients with 58 cases of breast cancer w ere evaluated preoperatively with MRI using a technique called the triple-a cquisition rapid gradient echo technique to maximize anatomic detail, Imagi ng results were compared with mammography and subsequent pathology results. Results: Magnetic resonance imaging correctly identified residual or primar y cancer in 55 of 58 cases and accurately predicted the extent of the cance r in 54 of 58 cases. The anatomic extent was more accurately defined with M RI compared with mammography (98% v 55%), Magnetic resonance imaging added the greatest value in cases of multifocal disease. Conclusion: By applying MRI selectively ta patients with a known diagnosis of cancer and focusing on defining the extent of malignant lesions, we were able to obtain clear and accurate anatomic information, Our results sugges t that MRI could provide very valuable information for preoperative plannin g and single-stage resection in breast cancer. Based on preliminary;lata fr am our series, MRI would be valuable as a staging tool in the preoperative setting even if the cost is in the range of $1,300 to $2,000, it is already significantly less than the target cost, so it is reasonable to refine thi s technique for clinical use to help plan the most appropriate surgical int ervention and possibly reduce costs as well. A careful prospective study is warranted to validate our findings. J Clin Oncol 17:110-119, (C) 1999 by American Society of Clinical Oncology.