MRI causes a can of worms?

Somebody will probably give a more detailed explanation than I can, but:

 MRIs have a tendency to give false-positive results and leads to unnecessary biopsies.

the MRI was a huge part of the dx phase for me but it was never suggested until I had been dx'd. I also had dense breasts. Digital mamo would be a good option but the MRI may pick up scar tissue and "other" stuff like menitoned above. The MRI was invaluable for me because we had planned a lumpectomy and it was only after the MRI that we knew that the tumor was too big for that. Mine had lobular features but was dxd as IDC. Doc said the lobular features allowed it to hide..it also showed all the biopsy spots and B9 cysts as well.

I really think that the MRI as a screening tool is questionable..Like PET's they can read a lot of false positives....I guess that's the can of worms she is referring to.

Yes that is the question isn't it. I really wish I had an answer for you and me.  I too have very busy breasts, my BS has been encouraging me to have a MRI for almost a year now, he's too warned me of the possibilty of hot spots which might  require more biopsies.  Isn't that what we all look forward to?

I am torn, I have always declined MRI's before, but since my last US showed an area with a thickened cyst wall I have been reconsidering,   My BS is very proactive and often reminds me of how easy it would be for something to be hiding amongst my many large cysts.  Having a family history of both paternal and maternal grandmothers with hx of breat cancer certainly raises the stakes.  I really wish I knew what to do.  Being a nurse does not give me any greater insight, however I understand that breast specific gamma imaging is not only sensitive but very accurate.  I believe this is a very new technogoly which is not being used to often beacuse of availabilty and cost.

Has anyone had BSGI, I would appreciate more information.

C, have another cup of coffee. 

Yes, using MRI for screening, even if you have dense breast tissue, apparently does create more problems. My BC was dx'd and treated at a major university hospital that is an NCI-designated comprehensive cancer center.  Once my tumor had been dx'd with a US-guided biopsy (it was never seen by mammography--even the digital variety), my BS ordered an MRI to look for other tumors in that breast or in the other one.  But, she will not order MRI for monitoring (which is actually screening) now that my BC has been treated.  She explained that MRI is too likely to generate false-positive results--thus, unnecessary biopsies.  MRI has been "approved" for screening in women at high risk of BC (women who are BRCA-positive, for example), but not for women at "average" risk.  Dense breast tissue supposedly increases our risk, but there has not been enough data on how breast density should be measured (objectively) and recorded.  She also said MRI is "approved" for evaluating the presence of other tumors in women who have been dx'd with a tumor but have not undergone treatment yet.

My BS is a surgical oncologist; she is a member of the review panel that produced the NCCN guidelines on BC screening.  So, she is following those guidelines. My onco is a medical oncologist; she is a member of the review panel that produced the NCCN guidelines on BC diagnosis and treatment.  She also says MRI is not an approved method for screening unless there is high risk of BC.

I need to note that the word "approved" is an official term, referring to FDA approval and/or approval by professional oncology organizations.  It also (probably) refers to approval by insurance companies, but my insurance company tends to follow the same official, medical guidelines as my doctors follow.

Yes, it's a can of worms for sure.

otter

I agree an MRI can open up a can of worms!  After my dx of IDC in the right breast I had an MRI that showed 14 lumps between the two breasts.  Although they weren't suspicious, I opted to have BMX with reconstruction.  My greatest fear was that if the lumps change at all I would need another biopsy and I didn't want to get on that emotional roller coaster again!  My final path report from the BMX showed that with the exception of the original cancer everything else was B9.  I don't regret the decision for BMX, it has given me a little peace of mind.

Alot of false positvies, sure.  MRI's are super sensitive and may lead to unneccessary biopsies.. but I credit my latest one for saving my life.  I had DCIS in 6/07 - calcifications showed up on a mammo - that's how it was diagnosed.  After that dx they did MRI's and mammos on me every 6 months.  15 months later in 11/08, my mammo came back all clear.  The MRI on the same day found invasive ductal carcinoma.  Had I not had the MRI, the IDC would have remained undetected and allowed to grow.  So, if MRI's open up a can of worms.. I'm glad the can was open in my case. I was always told I had dense complicated breasts too.  I agree with Kosh... better safe than sorry... we all know how important early detection is..... 

my oncologist used that expression too ----that an MRI would "open Pandora's box" --referring to the possibility of unecessary biopsies and the ensuing anxiety that goes along with them. But I told him I was willing to take that risk rather than have something invasive missed (I'm high risk from the combination of LCIS and family history)----I've had some suspicious "spots", but everything's been clear on the f/u mammo or US.

Anne

I am another person who had IDC diagnosed after a MRI.



My initial diagnosis was DCIS; I had calcifications that showed up on a mammogram. I had a lumpectomy and SNB. In addition, my surgeon felt a dimple on the underside of my breast during a pre operative exam. So he removed the tumor that was causing the dimple. It turned out to be IDC, 8 mm. Later when I read the radiologist's reports, it turned out that there was a shadow in my initial mammogram, but it didn't show up on a diagnostic mammogram and the area was not biopsied. 1+ for my surgeon.



When I met with my medical oncologist after my first diagnosis, he said that he didn't think a MRI was necessary as there were too many false positives. I didn't argue with him. However, when I had my initial appointment with the radiation oncologist, she asked me to get an MRI, to check for the extent of disease. I had the MRI; there were four suspicous areas. The radiologist was able to biopsy three of the areas, after I had an ultra sound to confirm the MRI results. One of the areas was IDC, 1.2 cm. 1+ for the radiation oncologist. 1- for my medical oncologist.



I recommend anyone who is dx with bc get an MRI to check for the extent of disease; you may have to have additional biopsies, but you will have a more complete picture before deciding on surgery.

I am also another one who credits the MRI with saving my life.  I have a strong family history of BC and had regular mammograms and some ultraounds for 15 years.  I had dense breasts so there was always that caveat on the mammogram results.  After I turned 50, my doctor ordered an MRI, as a baseline, he said.  Turns out that I had two areas of IDC that were not picked up on a mammogram six months before.  He said that they probably wouldn't have shown up for a year.  I encourage anyone with dense breasts and a family history to push for an MRI.

or not... i had an mri with contrast and a bsgi which both came back birads 2 - benign. i had an excisional biopsy last week and my results are idc stage la. there were no hot spots on either mri or bsgi. my cancer is only 3mm, which is very small and may be why it didn't enhance on the tests. my doctor also told me that no test is l00% accurate.

I am another one whose life was actually saved by an MRI...my mammo was clean, the palpation by oncologist, OB/GYN, and BS was fine.  On a whim, my onc said let's try an MRI just to be super sure.  I was violently opposed.  Ick, tiny tube, 40 minutes.  My onc just said give it a whirl, even ultra sound was clear.  He was OK with waiting six months anyway.  On a whim, my husband and I decided just to go and get it anyway and get it done.  (I had had previous BC and spent 5 years on tamoxifen.  No one thought it'd be anything but another tool in the arsenal, not even my onc.

Well, a big old 1.5 cm. tumor, hiding deep in chest wall.  Unseeable by mammo and unpalpable by human hands.  If I had not had that MRI, I'd be telling a different tale.

So get one.  It could literally save your life.  (BTW I was node negative, early stage IDCIS, good oncotype, clear blood markers.  No sign of this thing.

It's worth it. 

hi roorooep,

i had:

birads 4 mammo and ultrasound

benign stereotactic biopsy

fna biopsy with atypia

negative mri and bsgi

my breast surgeon and pcp both told me that the negatives do not cancel out the positives and that diagnosis is based on findings of multiple tests. since i did have the positive fna, the only way to know for sure was to have the excisional biopsy. unfortunately, now i need to go back for re-excision and sentinel node biopsy.

My sister had a lump not seen on mammogram.  Biopsy revealed cancer. She was going to have a lumpectomy but surgeon said to have an MRI, "just in case".  The MRI revealed additional areas of DCIS in both breasts so she had a dbl mst. She would have gone untreated if not for that MRI.

I get MRIs (and mammograms) now and they schedule them within 5-7 days of my period to reduce the false positives.  I'm told timing and an excellent radiologist who reads these all day can reduce the false positives.

Best of luck!

 hi "debnyc"

thanks for the info. 

roorooep