Follow-up screening with Magnetic Resonance Imaging
Multifocality and Multicentricity
If a significant lesion is found with an initial mammogram, MRI is often used to check for multifocality (more than one mass on the same breast ) and multicentricity (presense of a mass or lesion on the contralateral breast). This is routinely done as a preoperative staging procedure. Multifocal and multicentric tumors are succesfully detected through magnetic resonance imaging about 80% of the time. By comparison, a mammogram reveals multifocal and multicentric tumors about 45% of the time, with supplementary ultrasound increasing the sensibility to approximately 63%.
Follow-up of biopsy
Frequently a suspicious finding with a mammograph is followed-up with an appropriate biopsy. If a patient is classified as 'high risk' due to the discovery of lobular neoplasia or some other atypical celluar appearance, MRI may be used to reinforce a preliminary diagnosis.
Often a patient will present with a negative finding on a mammograph but a positive finding of axillary lymph node metastasis from biopsy samples from that region. In these cases MRI is used in a kind of 'reverse' investigation to discover the 'primary' tumor in the breast. The success rate for finding these 'occult' primary tumors in this manner is about 75%.
Post Operative use of Magnetic Resonance Imaging.
MRI is frequently used following surgical treatments to check for residual tumors. This is often performed within nine days of the intial surgery, but the most accurate readings are thought to occur after approximately 38-40 days. One of the challenges in the follow-up of lumpectomy, with or without radiation treatment, is that tumors are easily confused with predictable scar tissue development. A lumpectomy scar may contain vascularised granulation tissue up to 18 months following surgery. So there is a limited 'window' for accurate MRI investigations during this period. To avoid this potential confusion, best results are obtained no later than 5 weeks following the surgery. The success rate of MRI in differentiating scar from tumor recurrence is very high, 90% or more. Granulated scar tissue tends to be more regular and homogeneous around the surgery site, while cancerous cells tend to divide and spread in a somewhat random fashion. The use of post operative, follow-up MRI has been shown to 'alter' the original breast cancer treatment plans in up to 30% of cases.
Magnetic Resonance imaging following chemotherapy
The usefulnes of magnetic resonance imaging following chemotherapy remains unclear. There is consensus that MRI is useful for monitoring a patient's response to ongoing chemical therapy. By visually checking on the progress of the tumor, adjustments can be made to the drug regimen and the optimal timetable for surgical removal can to planned. A magnetic resonance image can clearly indicate the complete failure of the tumors response to chemotherapy if no change is evident. What MRI cannot definitively determine is whether or not there remains some microscopic residual disease at the end of a course of chemotherapy. Complete absense of carcinoma can only be determined through cellular analysis.
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Copyright Steven B. Halls, MD Last edited 06-December-2010