The Need for MRI Before Breast-Conserving Surgery

MRI has gained acceptance as a highly sensitive imaging modality for the detection of breast disease, with a potential role for surgical staging of patients with newly diagnosed breast cancer. Published literature suggests that MRI can detect additional cancer in the ipsilateral and contralateral breasts, thus supporting the use of MRI as a tool for the staging of patients considered for breast conservation therapy. Although the potential to provide relevant information is present, current MRI limitations involve the lack of specificity to differentiate between malignant versus high-risk and benign disease. For a small percentage of patients to benefit from the impact of MRI on surgical management, a larger percentage would need to undergo unnecessary biopsy or more extensive surgery. Given these caveats and lack of prospective trials demonstrating evidence of efficacy, caution should be exercised when deciding to routinely integrate MRI into the preoperative staging process.