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Magnetic resonance imaging of the breast: opportunities to improve breast cancer management.

Magnetic resonance imaging (MRI) is a relatively recent diagnostic tool for the breast, and the role of MRI in breast cancer management is evolving. As an adjunct to mammography and ultrasound, MRI can be a valuable addition to the work-up of a breast abnormality or biopsy-proven cancer. MRI has the advantages of providing a three-dimensional view of the breast, performing with high sensitivity in dense breast tissue and using non-ionizing radiation. MRI has significant disadvantages as well, including its high cost, variability in performance, and moderate specificity that, in combination with high sensitivity, often leads to unnecessary work-up. AsMRI findswider use, there is concern among clinicians that itmay lead tomoreaggressive treatments forbreast cancerwithout necessarily improving patient outcomes. MRI may be oversensitive, revealing noninvasive disease that may never progress, or residual disease that would be effectively treated by radiation. MRI also adds considerablecost topatient care.However, it is possible that judicious use of MRI could lead to changes in practice patterns that have been adopted based on outcomes using current methods for detecting and staging breast cancer. Many standards of care are applied broadly to groups of patients, although it is known that they benefit only a subset. The high sensitivity ofMRImay allow breast cancers to be characterized more precisely such that less invasive and better-tailored treatment options, including watchful waiting, can be used. This review discusses the current clinical applications for breast MRI and emerging areas where MRI has the potential to change and improve breast cancer management.