Dr Borgen on the Debate Over Routine MRI Testing in Early-Stage Breast Cancer

Patrick I. Borgen, MD, chair, the Department of Surgery, Maimonides Medical Center, head, the Maimonides Breast Center, the Maimonides Cancer Center, discusses the ongoing debate of routine MRI testing in early-stage breast cancer, highlighting the benefits and limitations of this approach.

MRI plays a pivotal role in breast imaging, as it offers high sensitivity detection of abnormalities compared with other modalities, Borgen begins. Rather than serving as a structural imaging test, MRI provides functional information by mapping patterns of vascularity. This makes it highly effective for identifying suspicious lesions, Borgen says.

One of the key advantages of MRI is its low false negative rate, which is estimated to be less than 5%, Borgen states. In comparison, the false negative rate for mammography or a 3D breast tomosynthesis can range from 12% to 15%, he says. This superior sensitivity makes MRI particularly valuable in cases where early detection is crucial, such as in young women with dense breast tissue or those at high risk of breast cancer, Borgen says.

However, the use of routine MRI in breast cancer is not without controversy, Borgen notes. Its high sensitivity comes at the cost of reduced specificity, leading to a higher rate of false positives and subsequent unnecessary biopsies, he explains. Moreover, MRI is a costly imaging modality, which can limit its widespread adoption and accessibility, Borgen adds.

The debate surrounding the use of MRI in breast cancer management reflects the need for personalized approaches based on individual patient characteristics and clinical scenarios, Borgen explains. Although some advocate for routine use of MRI to enhance detection and guide treatment decisions, others caution against its indiscriminate use, emphasizing the importance of weighing the benefits against the potential risks and drawbacks, he outlines.

Ultimately, the decision to utilize MRI in breast imaging should be based on a comprehensive evaluation of each patient's unique circumstances, including their age, breast density, risk factors, and treatment goals. Careful consideration of these factors can help optimize the use of MRI and minimize unnecessary interventions in breast cancer care.