Breast MRI for cancer detection and characterization: A review of evidence-based clinical applications

Rationale and Objectives. Breast MRI is an important new tool in the imaging armamentarium for the detection and characterization of breast carcinoma. Understanding the evidence-supported benefits and potential harms of breast MRI is important to ensure the appropriate utilization of this medical resource. Materials and Methods. This article reviews the clinical settings in which MRI for breast cancer assessment has been shown to be advantageous. The evidence regarding the diagnostic accuracy of MRI and the impact of this imaging tool on clinical outcomes are described. Novel breast MRI techniques which may lead to future improvements in performance are discussed. Results. Breast MRI has been shown in multiple studies to be advantageous for screening patients at high risk, evaluating patients with a new breast cancer diagnosis, monitoring treatment response in patients undergoing neoadjuvant chemotherapy and evaluating patients with metastatic axillary adenocarcinoma and unknown primary site. Among the limitations of MRI are its high cost and modest specificity resulting in false positive examinations. Conclusions. When used in evidence-supported clinical settings, the high sensitivity of MRI results in earlier cancer detection or greater accuracy of detection compared to existing tests for breast carcinoma. Further scientific endeavors are crucial to optimize the future performance and application of breast MRI.