Should I do an MRI before the lumpectomy?

cupcakes

I am 39 yrs old, IDC less than 1cm in left breast.  Stage 1.  I saw three doctors, of which two of them (strongly) recommended I go do an MRI before lumpectomy and one is adamant that I should NOT do an MRI.  I did research on this topic and it seems there is no consensus around this issue.  What did your doctor advise you to do?  Any information is appreciated!

Pennythoughts

I pretty much begged my BS to do an MRI and he refused.  He said it would not help in my decision for lumpectomy or mastectomy.  Since my 1st lumpectomy on Oct. 4, I have told him my concern - mammo and US have very difficult time seeing anything in my very dense breast tissue, and he finally conceded that after my surgeries and treatment, he might recommend an MRI for the regular, future check-ups rather than mammo and US.  I agree with you cupcakes - - it is very difficult to get a consensus on this topic - and there is so much information out there - - all conflicting it seems.

sweetaerobabe

Hi again cupcake, I just answered your other question.

I was sent for an MRI, found a second suspicious area, had to go to another hospital for an MRI guided biopsy (which was a disaster) Stupid Dr slid me back into the MRI machine and ripped out the tubes and needle that was in my breast, having nipple problems from it.

Anyway, after all that, it was neg. I just hope my nipple recovers, must have caused nerve damage because I have pain and an inverted nipple since that biopsy.

Lindissima

MRI Spotted Additional Breast Cancer in Women With Early Disease - OncologySTAT

My surgeon set me up for a pre-op MRI to rule out any cancer that did not show up on the mammogram.  Another onco  had recommended against it because there are a fair number of false positives, but I thought."Better a false positive that can be ruled out than to miss a cancer."

The above link relates to women considering partial breast radiation.  It shows that MRI found additional, previously undetected tumors in 11% of these (low risk) women.

A friend of mine, who went to a different hospital that does not do  preop MRI went in for a lumpectomy, then had to back for a mastectomy because she had a muti-focal tumor.

I'd like to know what the doctor's rationale  is for opposing MRI  in your specific case.

Good luck to you. 

lisa-e

The radiation oncologist I saw wanted me to have an MRI before starting radiation, after a lumpectomy.  As it turns out there, I had a another tumor.  I had a bmx, but was able to avoid radiation.  I wish the MRI had been done before the lumpectomy; I could have avoided a surgery.  I asked my onc about one shortly after my initial diagnosis.  He said he didn't recommend one - too many false positives.  I was happy to along with his recommendation, but as it turns out I shouldn't have been.

Now when someone asks me for advice after they have been diagnosed with bc, I recommend they get an MRI before any surgery.   

thegoodfight

Cupcakes,

Here's my story.  I found my lump, nothing ever showed in mammos, even after we knew this 3.5 cm lump was there from an ultrasound.  Went on to have lumpectomy with clean margins.  Started the decision making process for treatment, and I asked for MRI first to rule out any other undetected tumors especially in the other breast.   Well what do you know, other breast okay, but cancer breast had another small tumor in a different quandrant, 90% dcis and 10% idc.  That diagnosis came after removal and biopsies of suspicious areas in both breasts.  Again clean margins, so I went on to chemo and rads and now on Arimidex.  There was a question if I was going to do chemo before we found second cancer.  If I had gotten an MRI as part of my diagnosis I probably would have opted for a bmx at that point.  I am doing very well, and appear to be NED, but feel like I am waiting for other shoe to drop.  Hope I am lucky and don't face more cancer, but if I do, then the bmx decision will be easy.  My point.........................have that MRI.   Good luck to you.

Caren

lago

I'm glad mine did. They found LCIS in my other breast that they would have never found any other way since it didn't show up on the mammo or US! I had very dense breasts and I'm sure yours at 39 are dense too.

I would do the MRI.

nanaof2

I did have the MRI before surgery.  I say the more information gained from tests the better!

LRM216

I don't understand why YOU have to make this choice, being newly diagnosed and not being a breast surgeon.  When I was diagnosed I was sent right to a highly respected Women's breast center and the BS I made my appointment with told me what tests were needed and scheduled same, the breast MRI being one of them.  She wanted to be assured that there was nothing else lurking in either breast.  Fortunately, mine turned out well and showed only the 1.2 cm nodule picked up by mammo and US.  After all that treatlment was complete, I then went to my onc who also told me what tests she was scheduling, a PET (ins. co. wouldn't pay for it), so then she had me have a CT with contrast of chest, abdomen, pelvis, whole body bone scan and a heart echocardiogram prior to the surgery.  My onc, and many others, feel this is all standard testing to rule out any surprises down the road.  I would insist on them if I were you, and again, I am sorry that this burden seems to be put on your shoulders by the professionals.  You have enough to digest right now, you shouldn't have to be planning your own treatment plan and tests.

I wish you all the best,

Linda

oakley

I just had an MRI on Thursday pre-lumpectomy.  The BS words were "we don't want to have to go back in if there is another spot - we want to know now and then figure out how to deal with it."  I completely agree.  The more you know...

voraciousreader

I sure wish they would write MRI's into the Standard of Care following a breast cancer diagnosis, so there wouldn't be a discussion like this!  Furthermore, I wish that the Standard of Care would include a sonogram for women with dense breasts.  AND, I wish every woman would be advised, when she does have a mammogram, whether or not she has dense breasts so she gets that sonogram!

Long story short.  Been going for Mammograms AND sonograms for years! Mammogram missed my well-differentiated Grade 1 Pure Mucinous Breast Cancer, that looked like a cyst in my dense breasts, that the doctor felt. Ultrasound found it.  MRI found a drop of DCIS.  Thankfully, one surgery for both.

These doctors better get themselves on the same page!  I recently discussed this issue with my breast surgeon.  He shared the same sentiments as me.  He thought the radiologists were not doing a prudent job at advocating for these important additions to the Standard of Care.

thegoodfight

I think the reason there is some difference of opinion by our drs is because much of it is still unproven as far as the validity in diagnosing, many tests giving false positives.  My onc for example does not see a need for a pet scan.  I have not had one and would only have one if problems present.  I did have a CT with contrast and a bone scan and have had a followup repeat of both.  That being said, we are our own advocates and can ask for any test we want.  I asked for the MRI, not feeling confident with just mammos, since they never showed anything wrong.  I think the digitals are probably more accurate, but I still have a mammo and a MRI every year now, each about six months apart.   Do not be afraid of getting second opinions, do not be afraid of asking for what you want, and do not be afraid of changing doctors if you feel any level of discomfort.   Also don't forget that besides asking for what you want, you can also refuse what you don't want.  You are in charge.

BocaCiegaBabe

Knowing zip about any of this at diagnosis, I was surprised when my surgeon wanted an MRI before surgery.  I went without question and happily for me, my results were great...no other spots found.  That gave both him and me peace of mind that there wasn't something else, either in that breast or the other, just waiting to rear its ugly head!!  I really do not care about false positives...much better safe than sorry!!

voraciousreader

According to this article, last year, the NCCN recommended that doctors "consider" MRI following a breast cancer diagnosis.  "Consider"?  Ha! They couldn't be more direct?!

http://www.everydayhealth.com/breast-cancer/mri-role-after-breast-cancer-diagnosis.aspx

Mandy1313

I had an MRI AFTER the lumpectomy. Of course there was a tiny cancer that was found on that was found on the MRI and had been missed with the mammogram.   Still was able to have a lumpectomy for the second spot (3 doctors from 3 different cancer centers said it was ok).  But sure would have been better to have had the MRI BEFORE my first lumpectomy.  If you can, my advice would be to get the MRI before the lumpectomy. MRIs really do pick up tiny cancers that mammograms do not.

All the best.

voraciousreader

 Here's a study that was presented at the American Roentgen Ray Society 2010 meeting:

Breast Cancer Staging Should Include Breast MRI, Study Suggests

ScienceDaily (May 3, 2010) - Breast magnetic resonance imaging (MRI) can detect breast lesions missed on mammography and ultrasound and help surgeons plan the most appropriate surgical treatment, improving patient outcomes, according to a study presented at the American Roentgen Ray Society 2010 Annual Meeting in San Diego, CA.

Breast MRI offers valuable information about many breast conditions that cannot be obtained by other imaging modalities, such as mammography or ultrasound. As a result, it is increasingly being used for the preoperative evaluation of patients with newly diagnosed breast cancer.

The study, performed at the University of Rome "La Sapienza" in Rome, Italy, included 164 women with biopsy-proven breast cancer. Researchers analyzed how breast MRI influenced the surgical management choices of those patients.

"Breast MRI changed the therapeutic procedure previously proposed based on conventional imaging (mammography and ultrasound) for 32/164 patients," said Valeria Dominelli, MD, lead author of the study. "Breast MRI also detected 51 additional suspicious lesions not seen on mammography or ultrasound," said Dominelli.

"Breast MRI positively impacts patient management decisions and should be recommended for mapping tumor extent in patients with newly diagnosed breast cancer. The correct assessment of the disease can help the surgeon plan the most appropriate surgical treatment, possibly reducing the need for re-intervention," she said.

This study is pretty evident that the guidelines need updating!

BarbaraA

My breast surgeon ordered one so he would know what he was dealing with and I am very glad he did.

Drim

After my results came back positive for IDC following my biopsy for the tumor seen on mammo and U/S the doctors recommended I schedule an MRI. After the MRI was scheduled I met with 2 different BS's. One was very happy I had the MRI schedued and the other was indifferent (for reasons stated above). I had the MRI and it picked up something small in the cancer breast so they scheduled me for another U/S guided biopsy a week later. Went in for the biopsy but they couldn't see the spot on the U/S so they had to schedule me for an MRI guided biopsy so I waited another week. Then got a phone call that the machine was broken so they reschedule me for a week after that. This whole time I'm completely panicing (think I lost 10 pounds). By the time I got to the MRI guided biopsy (which by the way was the worst part of my whole cancer experience including surgury, chemo, herceptin, radiation, and tamoxifen) I was in tears just from the stress of it all. Finally got the biopsy done and got a phone call a few days later that everything was fine - not cancer!!

The bottom line is that this whole MRI process was extremely stressful, delayed my surgery and did not find anything, HOWEVER, I would do this all over again because ultimately knowing what's going on in there is better than the stress of not knowing.

susand

I had a mamo and ultrasound 1 month before I found my own lump.  They both came back clear.  Once I found my lump I had another ultrasound and mamo that only spoted the lump because I showed them exactly where to look.  After the biopsy and CA was confirmend I was told a lumpectomy was an option but they wanted to do an MRI first.  I was very lucky they did this as the MRI not only gave the exact size of the tumor but found a second tumor in a completely different area of the breast that had once again been missed by the mamo and sonogram.  I am so happy I only had to have one surgery.

Beesie

I'm another vote in favor of having the MRI.  My surgeon insists on it before he'll operate.  He wants to have the clearest picture possible of what's going on before he goes into the operating room and that means looking at films from a mammo, an ultrasound and an MRI.  In my case the MRI showed a much larger area of concern than what was seen on my mammo.  The MRI proved to be correct.

gutsy

Yes, I am also in favor of a MRI. It certainly changed the lay of the land for me. It gave a much clearer picture and also showed a larger area of concern than was noted in the mammo.

Fearless_One

I had a PEM before my lumpectomy, which is even more specific than an MRI.  I agree with the others.

CandDsMom

I am also in favor of the MRI - my MRI showed an additional 8x9x5 cm area with lots of little foci of DCIS that was not seen on the US or mammo. So my surgical plan was changed to automatic RMX from lumpectomy.

ginadmc

My BS ordered an MRI prior to lumpectomy. It showed what they expected from mammo, US and biopsy. It gave me some peace of mind before my surgery. However, it didn't show any node involvement which changed after lumpectomy and SNB. All 3 nodes from SNB had cancer in them so I had to go back for axillary dissection.

Gina

Pennythoughts

I am even more concerned now that my surgeon seems to not believe that an MRI would benefit me at this point.  Especially since I have had a history of fibrocystic breasts, extremely lumpy, dense tissue, and fibroid adenomas found in the non-cancer breast several years ago.  I agonized over the first surgery, Oct. 4/10 whether I should have Mx or lumpectomy.  Chose lumpectomy b/c I just didn't want to do a Mx if it wasn't absolutely necessary.

Got the call 3 weeks ago that margins were not clear, so am going for a re-excision on Weds. Nov. 17.  Still, no offer for an MRI.  I hate to think that after two lumpectomies, this still may not be over.  It seems that an MRI might eliminate some of the "crap shoot" approach that I feel is happening now.  Maybe it's b/c I'm in Canada . . . any other Canadians have this issue of docs not wanting to do MRI for BC?

Mollydog

I am a huge proponent of Breast MRIs.  In fact, I think they should become the standard, but that's because an MRI revealed that my breast cancer wasn't just a small shadowy spot on my left breast that the mammogram saw, but was, in fact, quite invasive.  No question, have the MRI.  Good luck and take care, Cupcakes.

voraciousreader

Pennythoughts - I've been corresponding on another board in England with a woman who also was diagnosed with Pure Mucinous Breast Cancer and her team of physicians WILL NOT agree to do an MRI for her.  According to her, since she is grade 1, it is NOT the Standard of Care!  She is beyond upset!

I just don't understand what is going on!  Reading this thread, it seems apparent that there is no down side to having one.  If it's negative, then there's peace of mind and no additional surgery.  If it's positive, then there needs to be additional surgery.  Seems like a no brainer.  MRI should be the Standard of Care during the initial staging, so that the correct treatment can commence.

Susie123

I think the standard of care with a good breast surgeon is to have an MRI prior to surgery. From what I understand, the MRI is a much better diagnostic tool than a mammogram or ultrasound. I strongly suggest getting an MRI prior to surgery, especially with a lumpectomy, since you're leaving most of your breast intact, and you want them to get it all the first time.    

susantm

When I was diagnosed with ILC, I read up as much as I could online. I found a friend of a friend who had gone through the same and recommended an MRI, since ILC in particular is more likely to be in both breasts. I talked it over with my surgeon, and he agreed to order an MRI for me. It found I had no other tumors, just the one already found. Thus it gave me peace of mind that I would not have had without it.

Beesie

Penny, it's your doctor.  And there are different points of view on this.  I'm in Canada too.  My first surgeon did not suggest an MRI but when I went for a 2nd opinion, this surgeon insisted on the MRI.  There are lots of women here who've had MRIs but it all depends on how the surgeon feels about it.  That's no different than in the U.S..

Anonymous

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