The Role of MRI in Breast Cancer and Breast Conservation Therapy
Abstract
:Simple Summary
Abstract
1. Introduction
1.1. Breast Cancer Overview
1.2. Diagnostic Value of Breast MRI
2. Breast MRI Technique and Interpretation
2.1. Breast MRI Protocol and Positioning
2.2. Primary Sequences for Breast MRI
2.2.1. T1-Weighted Sequences
2.2.2. T2-Weighted or STIR Sequences
2.2.3. Diffusion Weighted Imaging (DWI)
2.3. Breast Anatomy with MRI
2.4. Findings in the Breast on MRI
2.4.1. Focus
2.4.2. Mass (Figure 7B)
2.4.3. Non-Mass Enhancement (NME)
2.4.4. Background Parenchymal Enhancement (BPE)
2.4.5. Kinetic Curve Assessment
2.4.6. Identifying Cancers
2.4.7. Identifying Lymph Nodes
2.5. Breast Imaging Reporting and Data System
3. Clinical Utility of MRI for Breast Cancer
3.1. Identification of Cancer in the Breast and Axilla on MRI
3.1.1. Tumor Size Estimation and Factors Contributing to MRI-Pathology Concordance
3.1.2. Evaluation of the Pectoralis Musculature, Chest Wall, and Nipple–Areolar Complex
3.1.3. Multifocal/Multicentric Disease
3.1.4. Contralateral Disease
3.1.5. Evaluation of Axillary Lymph Nodes
3.1.6. Evaluation of Internal Mammary Lymph Nodes (IMLNs)
3.2. The Impact of MRI on Decisions for Breast Conservation Therapy
3.2.1. Breast Conservation Therapy
3.2.2. The Use of MRI for Preoperative Staging and Surgical Planning
3.2.3. Assessment of Tumor Response after Neoadjuvant Therapy
3.2.4. MR Imaging Response by Molecular Subtype
3.2.5. MR Imaging Response by Imaging Phenotype
3.2.6. MRI in Assessing Nodal Response to NAT
3.2.7. Systemic Therapy
3.2.8. MRI vs. FDG PET/CT in Assessment of NAT Response
3.3. The Role of MRI in Assisting with APBI Candidacy
MRI-Based Eligibility for APBI
3.4. Use of MRI for Post Breast Conservation Therapy Evaluation
Strengths | Limitations |
---|---|
High sensitivity [5,6,7,8,9,10] | Cost |
Tumor size estimation [55,56,57,58,59] | Accessibility |
Defining extent of disease | Claustophobia |
Pectoralis major/minor invasion [64,65] | IV gadolinium contrast allergy (rare) |
Invasion into the nipple–areolar complex [66] | Presence of a MRI incompatible implantable device |
Multicentric/multifocal disease [68] | |
Mammographically occult disease in contralateral breast [17,69,70,71,72,73,74] | |
Metastatic involvement of axillary or IMN nodes [36,52,77,78,79,91,96,97] | |
Tumor response to NAT [57,58,59,70,120,121,122,123,127,128,129,130] | |
Post treatment changes in the breast | |
Non-ionizing radiation |
4. Breast MRI for Radiation Treatment Planning
4.1. Identification and Sequences for Cavity and Clips
4.1.1. Identifying Seromas and Surgical Cavities
4.1.2. Identifying Surgical/Biopsy Clips
4.2. Treatment Planning Position and Co-Registration
4.2.1. CT Simulation Position
4.2.2. CT-MRI Co-Registration
4.3. Radiation Therapy Target Volumes
4.3.1. Lumpectomy Cavity
4.3.2. CTV and PTV Expansions
4.3.3. The Impact of MRI on Whole-Breast Radiotherapy Planning
4.3.4. Preoperative APBI
5. MRI-Guided Breast Radiotherapy
5.1. MRI-Linac Systems
5.2. Implications of Intrafraction Monitoring
5.3. Dosimetric Impact of the Magnetic Field on Breast Radiotherapy
5.4. Patient Position Considerations
6. Conclusions and Future Directions
Author Contributions
Funding
Conflicts of Interest
Abbreviations
ACR | American College of Radiology |
ADC | apparent diffusion coefficient |
AJCC | American Joint Committee on Cancer |
APBI | accelerated partial breast irradiation |
BCS | breast conserving surgery |
BCT | breast conservation therapy |
BI-RADS | Breast Imaging Reporting and Data System |
BPE | background parenchymal enhancement |
CTV | clinical target volume |
DCE | dynamic contrast-enhanced |
DCIS | ductal carcinoma in situ |
DWI | diffusion weighted imaging |
ERE | electron return effect |
ESE | electron stream effect |
FDG | fludeoxyglucose |
FGT | fibroglandular tissue |
GRE | gradient echo sequence |
ILC | invasive lobular carcinoma |
IMLN | internal mammary lymph node |
IOV | interobserver variability |
LC | lumpectomy cavity |
LR | local recurrence |
MBD | mammographic breast density |
MIP | maximum intensity projection |
MRI | Magnetic resonance imaging |
MRL | MR-linac |
NAC | neoadjuvant chemotherapy |
NME | non-mass enhancement |
NPV | negative predictive value |
OAR | organ at risk |
pCR | pathologic complete response |
PET/CT | positron emission tomography–computed tomography |
PPV | positive predictive value |
PTV | planning target volume |
RECIST | response evaluation criteria in solid tumors |
RFS | recurrence-free survival |
SBRT/SABR | stereotactic body radiotherapy |
SNR | signal-to-noise ratio |
STIR | Short-tau Inversion Recovery |
T | Tesla |
US | Ultrasound |
WLE | wide local excision |
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Indication Type | Evaluation of/for: |
---|---|
Screening |
|
Extent of Disease |
|
Additional Evaluation of Imaging or Clinical Findings |
|
Category | Assessment | Risk of Malignancy |
---|---|---|
0 | Incomplete–Need Additional Imaging Evaluation | N/A |
1 | Negative | Essentially 0% |
2 | Benign | Essentially 0% |
3 | Probably Benign | >0% but ≤2% |
4 | Suspicious | >2% but <95% |
5 | Highly Suggestive of Malignancy | ≥95% |
6 | Known Biopsy-Proven Malignancy | N/A |
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Washington, I.; Palm, R.F.; White, J.; Rosenberg, S.A.; Ataya, D. The Role of MRI in Breast Cancer and Breast Conservation Therapy. Cancers 2024, 16, 2122. https://doi.org/10.3390/cancers16112122
Washington I, Palm RF, White J, Rosenberg SA, Ataya D. The Role of MRI in Breast Cancer and Breast Conservation Therapy. Cancers. 2024; 16(11):2122. https://doi.org/10.3390/cancers16112122
Chicago/Turabian StyleWashington, Iman, Russell F. Palm, Julia White, Stephen A. Rosenberg, and Dana Ataya. 2024. "The Role of MRI in Breast Cancer and Breast Conservation Therapy" Cancers 16, no. 11: 2122. https://doi.org/10.3390/cancers16112122