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The FDA recommends that the MRI have at least a 1.5 Tesla magnet, a dedicated breast coil, and a radiologist experienced with breast implant MRI films for signs of rupture.
"For the majority of women at high risk, it is critical that MRI screening be provided in addition to, not instead of, mammography, as the sensitivity and cancer yield of MRI and mammography combined is greater than for MRI alone." The guideline provides information about 3 risk assessment models available for calculating breast cancer risk (BRCAPRO, Claus model, and Tyrer-Cuzick).
Software for each model is available online (see Appendix below).
New imaging techniques are being developed to overcome these limitations, enhance cancer detection, and improve patient outcome.
Digital mammography, computer-aided detection (CAD), breast ultrasound, and breast magnetic resonance imaging (MRI) are frequently used adjuncts to mammography in today's clinical practice.
The guidelines explain that all of the clinical trials screened participants with both MRI and mammography at the same time.
The guidelines state that there is no evidence to support one approach over the other.Due to MRI-detected lesions (in women who did not have additional malignancy on histology) conversion from WLE to mastectomy was 1.1 % (95 % CI: 0.3 to 3.6) and from WLE to more extensive surgery was 5.5 % (95 % CI: 3.1 to 9.5).The authors concluded that MRI staging causes more extensive breast surgery in an important proportion of women by identifying additional cancer, however there is a need to reduce FP MRI detection.They stated that randomized trials are needed to determine the clinical value of detecting additional disease which changes surgical treatment in women with apparently localized breast cancer.In a review on the utility of MRI for the screening and staging of breast cancer, Patani and Mokbel (2008) stated that while MRI can facilitate local staging, especially the evaluation of ipsilateral multi-centric or multi-focal lesions as well as synchronous contralateral disease that may be missed by conventional imaging; however, efficacy with respect to clinically relevant and patient oriented end-points has yet to be addressed in the context of clinical trials.This variability is an indicator that the risk models provide approximate, rather than precise, estimates of breast cancer risk.