Diagnostic Breast MRI Service

Introduction

Magnetic resonance imaging (MRI) is a highly sensitive imaging tool for breast disease. Breast MRI is now well established worldwide, where indications for its use in the management of breast disease are becoming clearer. The American Cancer Society now recommends annual breast MRI for women at high risk of breast cancer from the age of 30, screening asymptomatic women at high risk of breast cancer and Medicare Australia now provides a rebate for women under 50 years of age with a strong family history of breast cancer. An increase in validated indications for breast MRI has implications for the quality of service, and both the ACS and the USHCPs recommend a high level of training and experience for radiologists offering breast MRI, as well as the availability of computer aided diagnosis software (CAD) and breast biopsy facilities.
 
The Wesley breast clinic offers a unique breast MRI service. The service is integrated into the breast clinic, with each case reviewed by clinicians highly experienced in mammography, ultrasound imaging and breast MRI. The optimum imaging protocol can then be decided, and any adjunctive imaging obtained at the time of the breast MRI examination. The breast MRI service is headed by Professor Alan Coulthard, who is the co-editor of one of the leading textbooks on breast MRI and has over 15 years experience in the technique.
 
The Wesley Breast Clinic uses computer aided diagnosis (CAD) system for breast MRI with a linked breast intervention and biopsy system. The Wesley Breast Clinic has been performing Breast MRI since 2008.
 

Indications for breast MRI

Breast MRI does not replace mammography or ultrasound, but is a complementary imaging technique. The following clinical scenarios are accepted indications for breast MRI:
  • Evaluation of patients with breast implants
  • Follow up of patients with treated breast cancer
  • Evaluation of patients diagnosed with breast cancer (multifocality)
  • Screening of women at high risk of developing breast cancer
  • Evaluating patients with factors complicating non-MRI imaging (eg dense breasts, diffuse pathology)
  • Screening for primary cancer in metastatic presentations (search for an unknown primary cancer)

Which patients are at high risk?

  • Patients with a lifetime risk of 20-25% or above
  • BRCA1 of BRCA2 gene carriers
  • 1st degree relatives with BRCA1 or BRCA2 gene
  • Breast cancer related syndromes (Li Fraumeni, Cowden syndrome)
  • History of thoracic irradiation as a child

Does the patient need additional imaging?

Breast MRI at The Wesley Breast Clinic is part of a comprehensive imaging approach to breast disease. We will assess whether your patient needs up to date imaging with mammography or ultrasound prior to the breast MRI examination. Occasionally additional imaging with targeted ultrasound or mammography will be obtained subsequent to the breast MRI examination. In some cases MRI guided biopsy of suspicious tissue will be required.
 

How is the procedure performed?

The patient has an IV cannula inserted and then is positioned prone on the MRI table. A series of imaging sequences are acquired to provide both detailed morphometric and dynamic perfusion information. The dynamic images are acquired before and after IV injection of a paramagnetic contrast agent (gadolinium DTPA). The complete examination takes approximately 20-30 minutes.
 

The breast MRI report

A typical breast MRI examination may generate up to 2000 images, which may impact on the reporting time. At The Wesley Breast Clinic all studies are reviewed in the clinic using a dedicated computer workstation with CAD software. Mammography and ultrasound images are reviewed. The CAD software helps to highlight areas of possible pathology, which are then reviewed closely. The system generates a structured BIRADS report, in which all findings of note are documented, categorised and illustrated. A dictated report is also provided to accompany the BIRADS report, highlighting overall conclusions. The clinic aims to report all studies on the day of examination, with a finalised report available to the referring clinician within three working days.
 

What if a biopsy is required?

If a lesion is identified on MRI requiring tissue sampling, we will first try to locate the lesion using targeted ultrasound or mammography. If it can be localised in this way fine needle or core biopsy will be performed. If the lesion is only visible on MRI, we will recall the patient for MRI guided biopsy. The Wesley Breast Clinic uses a dedicated breast MRI biopsy system which is linked to CAD software. This system is one of the first to be installed in Australia and allows accurate localisation and biopsy of MRI detected lesions.

 


 

 

Additional Information - The Wesley Breast Clinic

  • Breast core biopsy

  • Breast implants

  • Common Breast Problems