Abstract
The clinical use of breast magnetic resonance (MR) imaging is increasing, especially for applications requiring paramagnetic contrast-agent injection. This document presents a synthetic list of acceptable indications with potential advantages for women according to evidence from the literature and the expert opinion of the panel that developed this statement. We generally recommend that breast MR imaging be performed in centres with experience in conventional breast imaging [mammography and ultrasonography (US)] and needle-biopsy procedures (under stereotactic or US guidance) as well as in breast MR imaging and second-look US for findings not revealed by conventional imaging performed before MR imaging. In our opinion, there is no evidence in favour of breast MR imaging as a diagnostic tool to characterise equivocal findings at conventional imaging when needle-biopsy procedures can be performed, nor for the study of asymptomatic, non-high-risk women with negative conventional imaging. After a description of technical and methodological requirements, we define the indications and limitations of breast MR imaging for surveillance of high-risk women, local staging before surgery, evaluation of the effect of neoadjuvant chemotherapy, breast previously treated for carcinoma, carcinoma of unknown primary syndrome, nipple discharge and breast implants.
Riassunto
La RM mammaria è in fase di crescente utilizzo clinico, soprattutto per le applicazioni che richiedono la somministrazione di mezzo di contrasto (MdC) paramagnetico. Il presente documento propone una codificazione sintetica delle indicazioni accettabili con potenziale vantaggio per le donne, secondo la valutazione delle evidenze presenti in letteratura e l’opinione del gruppo di esperti estensori del documento. In generale si raccomanda che l’indagine sia eseguita presso centri che siano in grado di combinare l’esperienza senologica relativa all’imaging convenzionale e ai prelievi agobioptici con quella specifica in RM mammaria e che garantiscano l’esecuzione del second look ecografico per i reperti non rilevati all’imaging convenzionale pre-RM. Non si ritiene che vi siano evidenze in favore dell’utilizzo della RM quale approccio diagnostico nella caratterizzazione di reperti equivoci all’imaging convenzionale in tutte le situazioni nelle quali sia praticabile il prelievo agobioptico sotto guida ecografica o stereotassica né in favore dello studio di donne non ad alto rischio asintomatiche e con imaging convenzionale negativo. Sono qui definiti i requisiti tecnici e metodologici di esecuzione dell’indagine e indicazioni e limiti relativi a: sorveglianza delle donne ad alto rischio di tumore mammario; stadiazione locale pretrattamento chirurgico; valutazione dell’effetto della chemioterapia neoadiuvante; mammella trattata per carcinoma; carcinoma unknown primary syndrome; mammella secernente; protesi mammarie.
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References/Bibliografia
Di Maggio C (coord.), Del Favero C, Frigerio A et al (2004) On behalf of Società Italiana di Radiologia Medica Charta Senologica 2004. Radiol Med 108:569–587
Heywang-Kobrunner SH, Beck R (1995) Contrast-enhanced MRI of the breast. 2nd ed. Springer-Verlag, Berlin
Sardanelli F, Iozzelli A, Fausto A (2003) Breast MR: indications, established technique and new directions. Eur Radiol 13[Suppl 3]:N28–N36
American College of Radiology (2004) ACR practice guideline for the performance of magnetic resonance imaging (MRI) of the breast. In: Practice guidelines and technical standards 2004. Reston, VA. See also: www.acr.org/s_acr/bin.asp?CID=549&DID=17775&DOC=FILE.PDF (Accessed 90/2008)
Kuhl CK (2007) Current status of breast MR imaging. Part 1. Choice of technique, image interpretation, diagnostic accuracy, and transfer to clinical practice. Radiology 244:672–691
American College of Radiology (2003) ACR breast imaging reporting and data system (BIRADS): breast imaging atlas. American College of Radiology, Reston
Baum F, Fischer U, Vosshenrich R, Grabbe E (2002) Classification of hypervascularized lesions in CE MR imaging of the breast. Eur Radiol 12:1087–1092
Perlet C, Heywang-Kobrunner SH, Heinig A et al (2006) Magnetic resonance-guided, vacuum-assisted breast biopsy: results from a European multicenter study of 538 lesions. Cancer 106:982–990
Sardanelli F, Podo F, D’Agnolo G et al (2007) Multicenter comparative multimodality surveillance of women at genetic-familial high risk for breast cancer (HiBCRIT study): interim results. Radiology 242:698–715
Sardanelli F, Podo F (2007) Breast MR imaging in women at high-risk of breast cancer. Is something changing in early breast cancer detection? Eur Radiol 17:873–887
Lord SJ, Lei W, Craft P et al (2007) A systematic review of the effectiveness of magnetic resonance imaging (MRI) as an addition to mammography and ultrasound in screening young women at high risk of breast cancer. Eur J Cancer 43:1905–1917
Saslow D, Boetes C, Burke W et al; for the American Cancer Society Breast Cancer Advisory Group (2007) American Cancer Society Guidelines for breast screening with MRI as an adjunct to mammography. CA Cancer J Clin 57:75–89
National Institute for Clinical Excellence (NICE), National Collaborating Centre for Primary care (2006) Familial breast cancer — The classification and care of women at risk of familial breast cancer in primary, secondary and tertiary care. Partial update. Draft consultation. May 2006. Available at http://www.nice.org.uk/nicemedia/pdf/CG41fullguidance.pdf
Sardanelli F, Podo F (2007) Management of an inherited predisposition to breast cancer. New Engl J Med 357:1663
Fischer U, Zachariae O, Baum F et al (2004) The influence of preoperative MRI of the breasts on recurrence rate in patients with breast cancer. Eur Radiol 14:1725–1731
Sardanelli F, Giuseppetti GM, Panizza P et al (2004) Sensitivity of MRI versus mammography for detecting foci of multifocal, multicentric breast cancer in fatty and dense breasts using the wholebreast pathologic examination as a gold standard. AJR Am J Roentgenol 183:1149–1157
Derloo E, Deterse JL, Rutgers E et al (2005) Additional breast lesions in patients eligible for breast-conserving therapy by MRI: Impact on preoperative management and potential benefit of computerized analysis. Eur J Cancer 41:1393–1401
Fischer U, Baum F, Luftner-Nagel S (2006) Preoperative MR Imaging in patients with breast cancer: Preoperative staging, effects on recurrence rates, and outcome analysis. Magn Reson Imaging Clin N Am 14:351–362
Lehman CD, Gatsonis C, Kuhl CK et al (2007) MRI evaluation of the contralateral breast in women with recently diagnosed breast cancer. N Engl J Med 356:1295–1303
Belli P, Costantini M, Malaspina C et al (2006) MRI accuracy in residual disease evaluation in breast cancer patients treated with neoadjuvant chemoterapy. Clin Radiol 61:946–953
Martincich L, Montemurro F, De Rosa G et alF(2004) Monitoring response to primary chemotherapy in breast cancer using dynamic contrast-enhanced magnetic resonance imaging. Breast Cancer Res Treat 83:67–76
Montemurro F, Martincich L, De Rosa G et al (2005) Dynamic contrastenhanced MRI and sonography in patients receiving primary chemotherapy for breast cancer. Eur Radiol 15:1224–1233
Partridge SC, Gibbs JE, Lu Y et al (2005) MRI measurements of breast tumor volume predict response to neoadjuvant chemotherapy and recurrence-free survival. AJR Am J Roentgenol 184:1774–1781
Pickles MD, Lowry M, Manton DJ et al (2005) Role of dynamic contrast enhanced MRI in monitoring early response of locally advanced breast cancer to neoadjuvant chemotherapy. Breast Cancer Res Treat 91:1–10
Tardivon AA, Ollivier L, El Khoury C, Thibault F (2006) Monitoring therapeutic efficacy in breast carcinomas. Eur Radiol 16:2549–2558
Belli P, Costantini M, Romani M et al (2002). Magnetic resonance imaging in breast cancer recurrence. Breast Cancer Res Treat 73:223–235
Kuhl CK (2007) Current status of breast MR imaging. Part 2. Clinical applications. Radiology 244:672–691
Morakkabati N, Leutner CC, Schmiedel A et al (2003) Breast MR imaging during or soon after radiation therapy. Radiology 229:893–901
Buchanan CL, Morris EA, Dorn PL et al (2005) Utility of breast magnetic resonance imaging in patients with occult primary breast cancer. Ann Surg Oncol 12:1045–1053
Galimberti V, Bassani G, Monti S et al (2004) Clinical experience with axillary presentation breast cancer. Breast Cancer Res Treat 88:43–47
Olson JAJr, Morris EA, Van Zee KJ et al (2000) Magnetic resonance imaging facilitates breast conservation for occult breast cancer. Ann Surg Oncol 7:411–415
Schelfout K, Kersschot E, Van Goethem M et al (2003) Breast MR imaging in a patient with unilateral axillary lymphadenopathy and unknown primary malignancy. Eur Radiol 13:2128–2132
Schorn C, Fischer U, Luftner-Nagel S et al (1999) MRI of the breast in patients with metastatic disease of unknown primary. Eur Radiol 9:470–473
Daniel BL, Gardner RW, Birdwell RL et al (2003) MRI of intraductal papilloma of the breast. Magn Reson Imaging 21:887–892
Hirose M, Otsuki N, Hayano D et al (2006) Multi-volume fusion imaging of MR ductography and MR mammography for patients with nipple discharge. Magn Reson Med Sci 5:105–112
Ishikawa T, Momiyama N, Hamaguchi Y et al (2004) Evaluation of dynamic studies of MR mammography for the diagnosis of intraductal lesions with nipple discharge. Breast Cancer 11:288–294
Nakahara H, Namba K, Watanabe R et al (2003) A comparison of MR imaging, galactography and ultrasonography in patients with nipple discharge. Breast Cancer 10:320–329
Orel SG, Dougherty CS, Reynolds C et al (2000) MR imaging in patients with nipple discharge: initial experience. Radiology 216:248–254
Azavedo E, Boné B (1999) Imaging breast with silicone implants. Eur Radiol 9:349–355
Berg WA, Caskey CI, Hamper UM et al (1993) Diagnosing breast implant rupture with MR imaging, US and mammography. Radiographics 13:1323–1336
Berg WA, Nguyen TK, Middleton MS et al (2002) MR imaging of extracapsular silicone from breast implants: diagnostic pitfalls. AJR Am J Roentgenol 178:465–472
Middleton MS, Mc Namara MP (2000) Breast implant classification with MR correlation. Radiographics 20:E1
Herborn CU, Marincek B, Erfmann D et al (2002) Breast augmentation and reconstructive surgery: MR imaging of implant rupture and malignancy. Eur Radiol 12:2198–2206
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Sardanelli, F., Giuseppetti, G., Canavese, G. et al. Indications for breast magnetic resonance imaging. Consensus document “Attualità in senologia”, Florence 2007. Radiol med 113, 1085–1095 (2008). https://doi.org/10.1007/s11547-008-0340-z
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DOI: https://doi.org/10.1007/s11547-008-0340-z