Mammography With IV Contrast There are limited data on the use of CEM in breast cancer surveillance. Sorin et al [203] did show a high incremental cancer detection rate (13.1 cancers per 1,000 women) when mammography with IV contrast replaced DM in patients with a personal history of breast cancer or with an intermediate lifetime risk. US (targeted and whole breast) increased the number of women needing biopsy from 80 to 134 without detecting additional malignancy. MRI Breast Without and With IV Contrast Although MRI does have greater sensitivity for malignancy than diagnostic mammogram alone, this use serves to detect asymptomatic disease. If there is a finding on the mammogram or US, then workup may be performed based on the most suspicious finding identified during the standard diagnostic workup. A mammographic finding can be sampled using tomosynthesis or stereotactic biopsy, and a sonographic finding can be sampled using US-guided biopsy. If mammogram and US are unrevealing, MRI is not useful as a problem-solving test, and, therefore, further management should be based upon the clinical symptoms. For example, evidence does not support the use of MRI Imaging of Invasive Breast Cancer in cases of a palpable breast mass without corresponding suspicious finding on mammography or US. In a study, 2 of 82 patients were subsequently diagnosed with malignancy with PPV of 25% [204], and in another, 3 of 167 women with PPV of 13% [205]. Finally, a third study starting with 22,004 women with palpable abnormalities demonstrated 9,334 with negative mammogram and/or US. Thirty-one of these patients underwent subsequent MRI, with 8 subsequent biopsies and no malignancies found [206]. MRI Breast Without IV Contrast There is no role for noncontrast MRI in the setting of suspected local recurrence based on signs and symptoms.
Imaging of Invasive Breast Cancer. Mammography With IV Contrast There are limited data on the use of CEM in breast cancer surveillance. Sorin et al [203] did show a high incremental cancer detection rate (13.1 cancers per 1,000 women) when mammography with IV contrast replaced DM in patients with a personal history of breast cancer or with an intermediate lifetime risk. US (targeted and whole breast) increased the number of women needing biopsy from 80 to 134 without detecting additional malignancy. MRI Breast Without and With IV Contrast Although MRI does have greater sensitivity for malignancy than diagnostic mammogram alone, this use serves to detect asymptomatic disease. If there is a finding on the mammogram or US, then workup may be performed based on the most suspicious finding identified during the standard diagnostic workup. A mammographic finding can be sampled using tomosynthesis or stereotactic biopsy, and a sonographic finding can be sampled using US-guided biopsy. If mammogram and US are unrevealing, MRI is not useful as a problem-solving test, and, therefore, further management should be based upon the clinical symptoms. For example, evidence does not support the use of MRI Imaging of Invasive Breast Cancer in cases of a palpable breast mass without corresponding suspicious finding on mammography or US. In a study, 2 of 82 patients were subsequently diagnosed with malignancy with PPV of 25% [204], and in another, 3 of 167 women with PPV of 13% [205]. Finally, a third study starting with 22,004 women with palpable abnormalities demonstrated 9,334 with negative mammogram and/or US. Thirty-one of these patients underwent subsequent MRI, with 8 subsequent biopsies and no malignancies found [206]. MRI Breast Without IV Contrast There is no role for noncontrast MRI in the setting of suspected local recurrence based on signs and symptoms.