Magnetic Resonance Imaging (MRI) Correlation to Standard of Care Imaging and Pathology Correlation in Breast Carcinoma

Background Information

In addition to the gold standard imaging of mammography and breast ultrasound, magnetic resonance imaging (MRI) has become a well established investigational modality for the diagnosis and staging of breast cancer. MRI demonstrates increased sensitivity and specificity relative to both mammography and breast ultrasound in the screening of women with an increased risk of breast cancer development (i.e. familial history of disease and / or genetic predisposition) and those who have very dense breast tissue. MRI has also proved to be very sensitive in the detection of multi-focal, multi-centric breast lesions, permitting the accurate staging of disease. However, despite this demonstrated efficacy, the standardization of MRI studies from one Institution to another is often difficult as each Institution will have a standard breast protocol with sequences set in accordance to the manufacturer of the machine and the manner in which the breast examinations have been designed.

At the Cross Cancer Institute (CCI) a breast MRI protocol based on the technical procedures recommended in the literature and personal scanning experience has been developed. However, due to the limited number of patients undergoing breast MRI examinations, our current experience is limited relative to the level of expertise demonstrated in the interpretation of breast ultrasound and mammographic scans. Fortunately, we now have the opportunity to obtain MRI - pathology correlation as Dr. Kelly Dabbs is performing on site breast cancer surgery at the CCI. We propose to obtain an MRI examination of all consented patients prior to their surgical procedure. The MRI results of each patient will then be compared to previous breast imaging (mammography and breast ultrasound) and histopathological specimens to determine the correlative accuracy of MRI with these techniques. To assess whether the size, grade, and presence of lymphovascular invasion or associated ductal carcinoma in situ influence the accuracy of MR imaging, all breast carcinoma subtypes will be included in this study.

As a teaching hospital, the CCI provides mammographic and breast ultrasound training to the Residents and the Diagnostic Radiology Program at the University of Alberta. Although breast MRI should be part of this training program, we currently do not have the necessary volume of breast MRI scans to provide Residents with adequate experience in this modality. The establishment of a breast MRI protocol, one which refers eligible CCI breast cancer patients for a pre-surgery MRI examination, will promote the development of expertise in this area, provide Residents with a comprehensive Breast program and keep the CCI at the leading edge of breast cancer care.

Objectives