Preoperative MRI as a Screening Tool for Diagnosing Contralateral Breast Cancer

March 31, 2024

The long-term impact of MRI screening impacts overall survival for patients

Compared to the incidence of breast cancer in general, women with breast cancer are twice as likely to develop contralateral breast cancer. This is the result of increasing instances of the disease, improved treatment options, and expanding life expectancy. 

Because delayed detection of contralateral breast cancer can result in the second round of treatment, a patient should undergo screening of the contralateral breast at the time of initial diagnosis in one breast. Screening is typically done via a combination of physical examination and mammography. However, this approach risks letting cancers go undetected, particularly in dense breasts, which tend to have a low sensitivity to mammography.

One option to fill this gap is preoperative MRI, which can be used to better assess tumor size and to detect other potential tumors in the same breast and in the contralateral breast.

Axial, fat-saturated, contrast-enhanced, and subtracted T1-weighted MRI scans in a 65-year-old woman with newly diagnosed breast cancer show (A) a 0.7-cm irregular homogeneously enhancing mass in the upper outer right breast (arrow) and (B) contralateral disease detected only with MRI as a 1.2-cm area of nonmass enhancement in the upper inner quadrant (arrow). After bilateral lumpectomy with sentinel lymph node biopsy, the final pathologic examination showed bilateral invasive ductal carcinoma, histologic grade I, with negative lymphovascular invasion, positivity for estrogen and progesterone receptors, and negativity for human epidermal growth factor 2 receptor; both were negative for axillary node disease. The patient underwent radiation therapy and then endocrine therapy for 5 years, with no evidence of local or distant recurrence 11 years after treatment.

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