Updated guidelines for physicians that represent best practices for using MRI to diagnose and make treatment decisions for breast cancer were published this month in the Journal of the National Comprehensive Cancer Network.

Breast radiologists and surgeons at the Seattle Cancer Care Alliance (SCCA) and the Roswell Park Cancer Institute in Buffalo, N.Y. authored the paper on which the guidelines are based.

Corresponding author of the paper, Connie Lehman, MD, said that the study summarizes an extensive review of published, peer-reviewed studies.

Key recommendations suggest that:

• MRI is not a substitute for screening or diagnostic mammography and, when indicated, diagnostic breast ultrasound. MRI supplements the use of these standard imaging tools in appropriately selected clinical situations;
• For women with diagnosed breast cancer, MRI provides enhanced detection in both the breast known to have cancer and the opposite, or "contralateral," breast;
• Surgical decisions should not be based solely on MRI findings because not all suspicious lesions on MRI are cancer. Suspicious lesions should be biopsied before a surgery plan is devised in order to avoid surgical overtreatment; and
• In the rare instances where cancer is found in the lymph nodes but not the breast, an MRI can find the location of cancer in the breast in nearly 60 percent of women.

Lehman, who is the director of radiology at the SCCA and a professor at the University of Washington School of Medicine in Seattle, said that research published over the last decade has supported the efficacy of breast MRI in finding cancers missed by mammography and ultrasound.

"The next phase of research is to understand more completely the impact of this improved cancer detection on treatment outcomes," she said.

Lehman and colleagues urge that clear standards for technical parameters be established, as well as performance measures at clinical sites that offer MRI.

The MRI guidelines adopted by the National Comprehensive Cancer Network (NCCN) state that MRI exams should be performed and interpreted by an expert breast-imaging team working in concert with a multidisciplinary diagnosis and treatment team. Breast MRI exams require dedicated equipment and breast-imaging radiologists who are familiar with the technical details for image interpretation. The NCCN guidelines also stated that imaging centers need to have the capability to perform MRI-guided needle biopsy sampling of lesions detected by MRI to properly evaluate possible abnormalities.