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MRI as an adjunct to triple assessment is well established, but often identifies additional lesions within the breast necessitating further characterisation. This study addresses the additional investigations generated by MRI.
A retrospective review of the MRI database between 2006 and 2009 identifying patients requiring investigations post MRI.
Over 4 years, 1,119 MRIs were performed on 717 patients, with 102 recalled for second-look ultrasound. Three patients were lost to follow-up. A total 124 incidental lesions were identified on MRI. Ultrasound identified 68 lesions, with definitive diagnosis following core biopsy/FNAC (62), surgery (two) core biopsy + repeat MRI (one) and MRI biopsy (three). Twenty-two lesions not identified by USS were assessed with X-ray-guided biopsy (two), MRI biopsy (13), interval MRI (five) or surgery (two). Nineteen MRI lesions following normal ultrasound had routine follow-up. Fifteen lesions (12 patients) did not have follow-up USS, as recommended following MDT discussion. Sixty lesions (44 patients) were malignant; MRI identified a primary in four patients presenting with lymphadenopathy and in 39 patients identified additional foci that changed management. Malignant lesions were identified on US biopsy/FNAC (38), X-ray-guided biopsy (one), MRI biopsy (seven) and surgery (14).
MRI identifies additional foci in 14% of patients. Malignant lesions will be identified in 43% of patients recalled. Comparison with 2005 data identifies a decreased recall rate and an increased cancer detection rate. Fifty per cent of additional lesions identified by MRI are malignant, of which 77% were confirmed preoperatively. Provision of a comprehensive breast MRI service must consider the resources needed to deliver the additional diagnostic investigations required.