Current indications for breast MRI

Screening

Screening of high-risk patients

Recent clinical trials have demonstrated that breast MRI can significantly improve the detection of cancer that is otherwise clinically and mammographically occult. Patients should be referred for screening breast MRI, preferably after careful risk assessment, by personnel trained in the assessment of hereditary breast cancer or by their referring physician who has used a risk assessment model. Breast MRI may be indicated in the surveillance of women with more than a 20% lifetime risk of breast cancer (for example, individuals with genetic predisposition to breast cancer by either gene testing or family pedigree, or individuals with a history of mantle radiation for Hodgkin’s disease).

Screening of the contralateral breast in patients with a new breast malignancy

MRI can detect occult malignancy in the contralateral breast in at least 3% to 5% of breast cancer patients.

Breast augmentation

The integrity of silicone implants can be determined by noncontrast MRI.  Breast MRI using contrast may be indicated in the evaluation of patients with silicone or saline implants and/or free injections with silicone, paraffin, or polyacrylamide gel in whom mammography is difficult.

Extent of disease

Invasive carcinoma and ductal cardinoma in situ (DCIS)

Breast MRI may be useful to determine the extent of disease and the presence of multifocality and multicentricity in patients with invasive carcinoma and ductal carcinoma in situ (DCIS). MRI can detect occult disease up to 15% to 30% of the time in the breast containing the index malignancy.

Invasion deep to fascia

MRI evaluation of breast carcinoma prior to surgical treatment may be useful in both mastectomy and breast conservation candidates to define the relationship of the tumor to the fascia and its extension into pectoralis major, serratus anterior, and/or intercostal muscles.

Postlumpectomy with positive margins

Breast MRI may be used in the evaluation of residual disease in patients whose pathology specimens demonstrate close or positive margins for residual disease.

Neoadjuvant chemotherapy

Breast MRI may be useful before, during, and/or after chemotherapy to evaluate treatment response and the extent of residual disease prior to surgical treatment. If used in this manner, a pretreatment MRI is highly recommended. MRI-compatible localization tissue markers placed prior to neoadjuvant chemotherapy may be helpful to indicate the location of the tumor in the event of complete response with no detectable residual tumor for resection.

Additional evaluation of clinical or imaging findings

Recurrence of breast cancer

Breast MRI may be useful in women with a prior history of breast cancer and suspicion of recurrence when clinical, mammographic, and/or sonographic findings are inconclusive.

Metastatic cancer when the primary is unknown and suspected to be of breast origin

MRI may be useful in patients presenting with metastatic disease and/or axillary adenopathy and no mammographic or physical findings of primary breast carcinoma.

Lesion characterization

Breast MRI may be indicated when other imaging examinations, such as ultrasound and mammography, and physical examination are inconclusive for the presence of breast cancer, and biopsy could not be performed (e.g., possible distortion on only one mammographic view without a sonographic correlate).

Postoperative tissue reconstruction

Breast MRI may be useful in the evaluation of suspected cancer recurrence in patients with tissue transfer flaps (rectus, latissimus dorsi, and gluteal).

MRI-guided biopsy

MRI is indicated for guidance of interventional procedures such as vacuum assisted biopsy and preoperative wire localization for lesions that are occult on mammography or sonography and demonstrable only with MRI.


MRI should not supplant careful problem-solving mammographic views or ultrasound in the diagnostic setting. Because MRI will miss some cancers that mammography will detect, it should not be used as a substitute for screening mammograms. MRI should not be used in lieu of biopsy of a mammographically, clinically, and/or sonographically suspicious finding.