Breast MRI and MRI-Guided Biopsies

At VM Medical we offer a wide range of advanced MRI services and are proud to be Canada’s first breast-dedicated MRI center, providing a high standard of detection and treatment for breast cancer

VM Medical is the world’s first site to combine the latest Siemens MRI technology with Sentinelle’s Vanguard breast coils to produce high quality breast MR imaging and MR breast biopsy capability. This unique partnership produces very precise breast images.

The Sentinelle table contains coils that can enhance the smallest details and help the VM Medical Breast MRI experts to distinguish benign from malignant signals. The Sentinelle’s Vanguard table also provides the most complete access possible for MRI-guided breast biopsies.

In addition, VM Medical was Canada’s first Siemens-Sentinelle designated Breast MRI Center of Excellence for image production, research, and staff training and testing for new MRI-guided biopsy technology.

More information on Breast MRIs

Early Detection

Two newer landmark papers have now established MRI as an integral breast screening modality.

In 2007, there was a review done by the American Cancer Society with guidelines for breast screening with MRI as an adjunct to mammography (CA Cancer J Clin 2007;57;75-89). This review article contains the American Cancer Society’s new recommendations for regular monitoring using breast MRI:

  • Gene carriers and their first-degree relatives
  • All patients with a 20% lifetime risk as defined by recognized risk tools, such as those utilized at the VM Medical Breast Cancer Risk Assessment Clinic
  • Patients with prior chest radiation between ages 20 and 30
  • Certain patients included in the following categories (based on their individual cumulative risk factors):
    • Lifetime risk over 15%
    • Lobular carcinoma in situ (LCIS)
    • Atypical lobular hyperplasia (ALH)
    • Atypical ductal hyperplasia (ADH)
    • Heterogeneously dense breasts on mammography
    • Women with a personal history of breast cancer

These recommendations are conditional on an acceptable level of quality of MRI screening, which should be performed by experienced providers in facilities that provide MRI-guided biopsy for the follow-up on any suspicious result.

A Research Study

A 2007 study published in the “New England Journal of Medicine” titled MRI Evaluation of the Contralateral Breast in Women with Recently Diagnosed Breast Cancer (N Engl J Med 2007;356;13:1295-1303) discussed the importance of screening. In this study, MRI detected 30 clinically and mammography occult tumors in the contralateral breast in 969 patients with an established breast cancer. MRI detection was not marred by breast density. Forty percent of the tumors detected by MRI were ductal carcinoma in situ (DCIS) and the average size of the invasive tumors, all nodes negative, were 10.9 mm. Since these tumors are likely to progress and some can eventually metastasize if untreated, early detection is very important. The authors thus recommend considering an MRI prior to undertaking surgery or neo-adjuvant therapy.

Early Detection is Important

The accompanying editorial suggested that the control of breast cancer for the foreseeable future will depend mostly on early detection, careful diagnostic evaluation and appropriate therapy. The editorial also pointed out that ultrasonography, MRI, and digital mammography will improve the outcome when they are used as a substitute for, or an adjunct to, conventional film mammography for women in whom the latter has not been useful. While supporting MRI, digital mammography has recently been shown to be a more effective imaging tool in younger women. Since conventional film mammography does not identify all breast cancers, newer imaging tools such as MRI and digital mammography can fill this void.

Prior Indications

Breast MRI has already been recognized as a very important breast imaging modality for higher risk patients based on accumulated and convincing data from numerous clinical trials done in the mid to late 1990s. Despite substantial differences in patient population and MRI technique, all reported significantly higher sensitivity for MRI compared to both mammography or any of the other modalities used. Kriege had screened 2000 unaffected patients aged 25 to 70 with an estimated 15% risk of breast cancer (19% proven gene carriers) and reported that 80% of the tumors were detected by MRI versus 33% by conventional film mammography, and tumors picked up by MRI were smaller than those detected by film mammography. Five subsequent trials in high risk patients produced similar results, with MRI sensitivity ranging from 71% to 100% versus 16% to 40% for film mammography.

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