December 3, 2023

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Breast cancer: How much do you know about breast MR?

Breast cancer: How much do you know about breast MR?


Breast cancer: How much do you know about breast MR?  Let’s take a look at the common problems of breast magnetic resonance examination!

Breast cancer is one of the most common malignant tumors in women, which seriously affects the normal life of patients. In recent years, this disease tends to be younger, and it is more common in women with a high standard of living and higher education. The incidence is increasing year by year. Therefore, breast examination has become an important part of the annual routine physical examination.

At present, our common clinical examinations are X-ray photography and ultrasound examinations, while breast magnetic resonance examinations are rarely used. However, breast magnetic resonance examination has its unique advantages, such as significant soft tissue resolution and higher sensitivity than other examinations. In recent years, with the continuous improvement of magnetic resonance technology, it can be used for morphological hemodynamics and molecular biology. The evaluation of lesions has gradually become an indispensable and important means of breast examination.

Let’s find out: Frequently asked questions about breast magnetic resonance examination!



A. What kind of person needs a breast magnetic resonance examination?

1. Diagnosis of breast cancer:

When the nature of the lesion cannot be determined by mammography or ultrasound imaging, MRI can be considered for further examination.

2. Breast cancer staging:

Because MRI is highly sensitive to invasive breast cancer, it is helpful to find multiple lesions and multicenter lesions that cannot be detected by other imaging examinations, and to display and evaluate the effects of cancer on breast fascia, pectoralis major, serratus anterior and intercostal Violation of muscle. Before formulating a surgical plan, especially when considering breast-conserving treatment, it is recommended to perform breast enhancement MRI.

3. Evaluation of the efficacy of neoadjuvant chemotherapy:

For breast cancer patients receiving neoadjuvant chemotherapy, MRI before chemotherapy, during chemotherapy, and at the end of chemotherapy can help assess the response to chemotherapy and determine the extent of residual lesions after chemotherapy.

4. Axillary lymph node metastasis, but the original lesion is unknown:

When metastatic lymph nodes have appeared in the armpits, but clinical examination, X-ray photography, and ultrasound have failed to identify the primary lesions, MRI can help to find hidden cancer lesions in the breast and determine the location and scope of further treatment. Negative MRI results can help eliminate primary breast lesions and avoid unnecessary mastectomy.

5. Surveillance of recurrence after breast-conserving surgery:

After breast-conserving surgery (including plastic surgery) for breast cancer patients, clinical examination, mammography or ultrasound cannot determine whether there is a recurrence. Magnetic resonance imaging can help distinguish tumor recurrence from postoperative scars.

6. Follow-up after breast plastic surgery:

For people who have difficulty in evaluating mammography after breast prosthesis implantation, magnetic resonance imaging can help diagnose breast cancer and assess the integrity of the implanted prosthesis.

7. Screening for high-risk groups:

Among the high-risk populations who are susceptible to breast cancer, MRI can find clinical, mammography, and ultrasound negative breast cancers.

8. Needle biopsy guided by magnetic resonance.



B. What are the disadvantages of breast MR examination?

1. If there are magnetic substances installed in the patient’s body, it is not suitable for nuclear magnetic examination

2. If patients are allergic to contrast agents, they cannot undergo nuclear magnetic examination;

3. For patients with claustrophobia, it is not suitable for patients with claustrophobia to panic because of the small space for MRI examination;

4. Patients who cannot lie on their stomachs cannot undergo MRI examination;

5. Compared with other examinations, the cost of nuclear magnetic examination is relatively more expensive in breast examinations.



C. When is breast MR examination usually performed?

1. 7-14 days after the end of menstruation (avoid physiological strengthening)

2. 6 months after surgery

3. 12 months after radiotherapy

4. 4-6 weeks after hormone replacement therapy is stopped



D. What are the precautions for breast MR examination?

The examination should be performed in the prone position for 15-20 minutes. An empty stomach is required 2 hours before the examination. After the examination, it is recommended to drink more water. About 90% of the contrast agent is excreted in the urine within 24 hours; in order to avoid hormone levels in the menstrual cycle It may increase the false positive effect of breast lesions. It is recommended that the inspection time window is the 2nd to 3rd week after menstruation, and the second week is the best.



E. What is the BI-RADS classification of breast MR report? What are the suggestions for different classifications?

Grade 0: It does not mean that there is no problem, but it means that the assessment is incomplete and the doctor can not be sure. It is recommended to recall the patient, take special postures or other imaging examinations;

Grade 1: Refers to the normal breast, only need to do routine physical examination every year;

Grade 2: Refers to lesions that are basically benign, with almost no possibility of malignancy. Only need regular review of the tail link;

Grade 3: Refers to lesions, but basically benign lesions, the possibility of malignancy is less than 2%. For such patients, it is generally recommended to review every six months. If the size and shape of the mass change significantly, surgery must be considered If there is no obvious change in the size and shape of the mass, just continue to observe. If the patient is very anxious and is over 40 years old, or the clinician feels that the imaging findings do not match the clinical findings, a biopsy will be recommended;

Grade 4: The possibility of malignancy is higher. Grade 4a means that the probability of malignancy is 3%~10%, 4b means that the probability of malignancy is 10%~50%, and the probability of grade 4c is 50%~95%. For such patients, they may be malignant at any time. If it is benign, it can be reviewed once every six months and continue to observe. If it is malignant, it must be actively treated. If it can be operated on, it must be treated, and if it cannot be operated on, it must be treated conservatively;

Grade 5: It means that it is a typical malignant manifestation, and the possibility of malignancy is greater than 95%. Such patients need immediate treatment;

Grade 6: It means that breast cancer has been confirmed pathologically, but the doctor needs to make a treatment strategy, and you need to do another examination. The imaging doctor will report 6 categories.



(source:internet, reference only)

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