Use of MRI in breast cancer

introduction

Magnetic resonance tomography (MRT) is an imaging process that is used in medical diagnostics to assess the structure and function of organs. In contrast to X-rays or computed tomography (CT), no ionizing (radioactive) Radiation is used, but the principle of nuclear magnetic resonance is applied.
According to the current state of research, the MRI is completely harmless.
The duration of an MRI scan is usually around 20 minutes.

Benefits of an MRI scan for breast cancer

Compared to the classic breast cancer (Breast cancer) Diagnostics, i.e. mammography and sonography, the rate of actually detected breast cancer cases using an MRI is significantly higher.
Especially so-called DCIS (ductal carcinoma in situ) are often not recognizable in an X-ray image or by means of sonography. For this reason, many doctors have long called for the widespread inclusion of MRIs of the female breast in breast cancer screening. MRI is also used to diagnose breast cancer in men

Nonetheless, the usefulness of magnetic resonance imaging in breast cancer is controversial for a number of reasons. Various studies examined the benefits of breast MRI in high-risk patients, but found no evidence that high-risk patients who had a tumor detected on MRI lived longer or had a lower rate of recurrence. In addition, microcalcifications are much more visible in mammography.

Contrast media MRI in breast cancer

To im MRI As with other imaging techniques, it becomes common to be able to better represent certain structures in order to be able to see breast cancer with certainty Contrast media used.
In case of Breast cancer diagnostics will do this Gadolinium used, which in the last third of the MRI procedure has a Venous catheter is injected. Malicious (malignantIn the following minutes, tumors absorb the contrast agent much faster than healthy mammary gland tissue and can thus be easily differentiated from the surrounding healthy tissue.

The administration of contrast media can be very rare allergic reactions to lead. These are mainly expressed in Rashes or itching.
Generally considered MRI contrast media but much better tolerated than iodinated Contrast media like those at X-rays be used.

Read more on this topic at: MRI with contrast agent

Prevention / early detection

To Diagnosis from Breast cancer will the Magnetic resonance imaging still not widely used in Germany. According to the current medical guidelines (S3 guideline) should be a Contrast MRI are not routinely used for pretherapeutic, i.e. also preventive, diagnostics.

It is recommended as a supplementary diagnostic procedure, especially if the family is at risk. This is particularly relevant for mutation carriers of the BRCA1- or BRCA2 gene. Carriers of this gene fall ill on average 20 years earlier than women without any inherited family risk. In addition, their risk of developing breast cancer at some point in their life is 50 - 80%, significantly higher than that of the normal population. According to the S3 guideline, patients with a high family risk are recommended to have an MRI every 12 months from the age of 25 (or 5 years before the earliest age of onset in the family) up to the age of 55.

Another indication for an MRI is, among other things, an unclear finding after conventional diagnostics (Mammography and Sonography) or if a Lymph node metastasis was found, but not Primary focus was to be found. An MRI is also indicated if lobular carcinoma is suspected. These occur significantly more often than other breast cancers in several Breast quadrants (multi-tric) or even in both at the same time Breasts (bilateral) and are therefore considered more dangerous. Furthermore, an MRI scan is used in women <40 years of age if breast cancer is suspected.
Even with patients Breast implants can do an MRI Breast cancer diagnosis be useful, as silicone implants impair the view of the glandular tissue behind them.

Even if a magnetic resonance imaging in the above mentioned cases makes sense, is the breast MRI no standard benefit from statutory health insurances.
In the case of privately insured persons, the costs are usually covered if the indication is given.

Aftercare

Are surgery, chemotherapy and Radiation therapy When the breast cancer patient has finished, the follow-up period begins, which lasts about 5 years.
For the first 3 years, a Mammography carried out.
A MRI however, usually belongs Not for standard follow-up care for breast cancer. This is only in the context of the Metastasis diagnostics or indicated for clinical abnormalities.
In addition, an MRI can be performed for follow-up for local diagnosis of recurrence if it is not possible to clearly differentiate between scar tissue and recurrence.

Differentiation of scar tissue and breast cancer after surgery in the MRI

An MRI after surgery is very suitable. That which arises during surgical interventions Scar tissue can judge a X-ray mammography or one Sonography make it more difficult or even impossible. In magnetic resonance imaging, however, due to the Contrast enhancement of tumor tissue tumor in most cases well distinguished from scar tissue.
Exists after an already done Breast surgery So if a relapse is suspected, an MRI can be prescribed. However, this is possible at the earliest 6 months after the previous operation and 12 months after the completion of a follow-up irradiation.

costs

Magnetic resonance imaging is due to them good resolution in the soft tissue a very good diagnostic tool for breast cancer. In everyday clinical practice they can do the X-ray mammography or the Sonography the breast still not replace it until now. The not insignificant cost differences of the examinations certainly play a role!
On the one hand, this is due to the fact that they are very expensive and time-consuming examinations and therefore only make sense for specific questions. Because of this, the statutory health insurance companies only cover the costs of the examination in certain cases.
In some hospitals and breast centers it will be above all Breast cancer surgeries an MRI performed regardless of the patient's insurance status.
An examination for self-payers costs about 300 to 450 euros, the costs of private health insurance are higher.

You can find more detailed information on this topic at: Cost of an MRI examination