University of Virginia Health System

U.Va. Health System Uses MRI in Detection of Breast Cancer

Yet she knew something was wrong. So two months later, her surgeon referred her to the University of Virginia Health System for a magnetic resonance imaging (MRI) procedure. The MRI, taken on January 14, detected a suspicious lesion. The woman came back for a surgical biopsy on February 1, and Dr. Gia DeAngelis, associate professor of radiology at U.Va, used MRI for guidance to insert a small wire into the lesion to help surgeons locate it. The results of the biopsy showed that the lesion was cancerous, and the woman returned to her surgeon in Harrisonburg for a mastectomy.

The woman, who asked that her name not be used, feels very fortunate that U.Va. offers MRI for breast cancer evaluation. I'm very thankful that with the MRI we were able to find the tumor and remove my breast before the cancer had spread any further.

Traditional mammography uses radiation to produce two-dimensional images of the breast to show variations in tissue density, said DeAngelis. MRI, however, uses a magnetic field to produce three-dimensional images of the breast that show variations in the water content of tissues.

When we inject contrast dye into the breast and perform an MRI, the dye preferentially collects first in masses with increased blood flow, such as cancers, causing them to become bright on the image, DeAngelis said. Another reason MRI is so effective is that it can take very thin images through the whole breast so that even small cancers can be picked up. Overall, it's about 95 percent sensitive in picking up invasive cancers.

But a breast MRI is not a replacement for a mammogram, DeAngelis said. For most women, a mammogram is very sensitive in detecting breast cancer, especially when the breasts are not particularly dense. One difficulty with MRI is that many benign lesions can become bright with the contrast dye, although we can often judge from the appearance of the lesion whether it is likely to be benign or if it needs to be biopsied. And finally, the cost of an MRI is $1400, while a screening mammogram is only $65.

U.Va. is one of 14 centers in the country participating in a large clinical trial, led by the University of Pennsylvania, to test the indications of MRI in the diagnosis and detection of breast cancer and in screening women at very high risk of breast cancer.

While the majority of breast cancers are visible by mammogram, I think MRI has an important role in determining the extent of breast cancer and in helping physicians plan treatment for women with breast cancer, DeAngelis said. This study will help us determine just what that role is.

For more information, call Dr. Gia DeAngelis at (804) 924-5173.

April 28, 1999