Preoperative Breast Magnetic Resonance Imaging

Guideline Objective:

To make recommendations about whether preoperative breast magnetic resonance imaging (MRI) should be added to conventional imaging (mammography and/or ultrasound) in patients with newly diagnosed breast cancer, and to make recommendations about specific indications if evidence allows.

Patient Population:

Patients diagnosed with breast cancer of any stage for which additional information on disease location or extent in the breast obtained prior to surgery may influence staging, treatment, or prognosis.  The guideline does not address patients diagnosed with breast cancer but without an identified cancerous lesion in the breast (occult breast cancer).

Intended Guideline Users:

1. Radiologists, surgeons, and other clinicians involved in determining extent of disease and treatment of patients diagnosed with breast cancer.
2. Members of the Breast Cancer Advisory Committee, Ontario Health (Cancer Care Ontario) (OH [CCO]) staff, and others involved in the review and update of the Breast Cancer Pathway Map.

Research Questions:

In patients with newly diagnosed breast cancer, does additional information on extent of disease obtained by use of preoperative breast MRI after mammography and/or ultrasound (a) change the type or extent of surgery (breast-conserving surgery, unilateral or bilateral mastectomy), type or extent of radiation therapy, or use of adjuvant therapy; or (b) improve patient outcomes such as recurrence, disease-free or event-free survival, distant metastasis-free survival, overall survival, rates of re-excision or re-operation, or quality of life?

This guideline is based on evidence summary ES 1-25 completed in December 2021