Imaging of Invasive Breast Cancer Still, there is no evidence that preoperative MRI leads to improved survival or decreased recurrence, including data from multicenter analyses [61,68,83-85]. In 3,180 affected breasts in 3,169 women (median age, 56.2 years), 8-year disease-free survival did not differ between the MRI (97%) and the non-MRI (95%) groups (P = . 87), and the multivariable model showed no significant effect of MRI on disease-free survival: HR for MRI (versus non-MRI) was 0.88 (95% CI, 0.52-1.51; P = . 65); age, margin status, and tumor grade were associated with disease-free survival (all P < . 05) [85]. Of the 31,756 patients included in a survival cohort (70% non-MRI and 30% MRI), breast MRI was not significantly associated with overall survival (HR, 0.91; 95% CI, 0.74-1.11, P = . 35) or with disease-free survival (HR, 1.16; 95% CI, 0.81-1.67), even among the different histological subtypes. The lack of survival benefit extends also to patients with ILC, despite improved surgical outcomes in this population as described above [83]. Given these data, benefits of preoperative MRI for additional cancer detection or delineating extent of disease should be balanced with the possibility of a false-positive diagnosis leading to additional biopsy or unnecessary additional imaging. MRI Breast Without IV Contrast There is no evidence to support the use of noncontrast breast MRI in evaluating extent of disease. US is the most established noninvasive imaging test for assessing the axilla following a clinically or imaging detected suspicious lymph node. US features associated with a higher likelihood of malignancy include short-axis lymph node size >1 cm, cortical thickness of >0.3 cm, and absence of a fatty hilum [90-93]. There is a wide range of reported sensitivity and specificity for axillary US, and none of these imaging features are specific enough to avoid the need for histologic sampling.
Imaging of Invasive Breast Cancer. Imaging of Invasive Breast Cancer Still, there is no evidence that preoperative MRI leads to improved survival or decreased recurrence, including data from multicenter analyses [61,68,83-85]. In 3,180 affected breasts in 3,169 women (median age, 56.2 years), 8-year disease-free survival did not differ between the MRI (97%) and the non-MRI (95%) groups (P = . 87), and the multivariable model showed no significant effect of MRI on disease-free survival: HR for MRI (versus non-MRI) was 0.88 (95% CI, 0.52-1.51; P = . 65); age, margin status, and tumor grade were associated with disease-free survival (all P < . 05) [85]. Of the 31,756 patients included in a survival cohort (70% non-MRI and 30% MRI), breast MRI was not significantly associated with overall survival (HR, 0.91; 95% CI, 0.74-1.11, P = . 35) or with disease-free survival (HR, 1.16; 95% CI, 0.81-1.67), even among the different histological subtypes. The lack of survival benefit extends also to patients with ILC, despite improved surgical outcomes in this population as described above [83]. Given these data, benefits of preoperative MRI for additional cancer detection or delineating extent of disease should be balanced with the possibility of a false-positive diagnosis leading to additional biopsy or unnecessary additional imaging. MRI Breast Without IV Contrast There is no evidence to support the use of noncontrast breast MRI in evaluating extent of disease. US is the most established noninvasive imaging test for assessing the axilla following a clinically or imaging detected suspicious lymph node. US features associated with a higher likelihood of malignancy include short-axis lymph node size >1 cm, cortical thickness of >0.3 cm, and absence of a fatty hilum [90-93]. There is a wide range of reported sensitivity and specificity for axillary US, and none of these imaging features are specific enough to avoid the need for histologic sampling.