CTA: How important is patient preparation?
Dr Vinnicombe: It is impossible to overemphasize the role of sympathetic MR technicians who can talk the patient through the procedure and, crucially, who are not afraid to manipulate the breast to optimize patient positioning within the breast coil. Cod liver oil capsules taped to the skin can be useful to mark scars or the site of the clinical abnormality.
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The patient has to be able to lie prone without moving for a minimum of 25 minutes, and comfort is essential. In my unit, the patient information sheet warns patients to avoid a large meal prior to the scan, as this can make lying prone for the procedure very uncomfortable. The more time spent ensuring the breasts lie centrally within the coil, with no skin folds, the better the technical quality of the scans will be. The patient information sheet should also warn the patient that we may need to do a supplemental ultrasound scan after the MRI to evaluate any unexpected findings.
CTA: What do radiologists need to know before preparing a breast MRI report?
Dr Vinnicombe: Probably the single most important factor in the issuing of a helpful report is a thorough understanding of the precise clinical question and of the findings that will influence the treatment plan. This has never been more important than at present, when we are in the throes of a remarkable change in the treatment of both early stage and locally advanced breast cancer.
If we are to do no harm, the onus is on us to appreciate the limitations of the technique, and to issue a clear and concise report that details the level of concern and the actions, if any, that need to be taken. I am a great believer in brevity when it comes to reports; I want my reports to be read! I tend, therefore, not to exhaustively list all the scan parameters and all the normal/benign findings in too much detail.
For radiologists whose experience of reporting breast MRI is limited, the use of structured reporting with a standardized lexicon, like the ACR BI-RADS lexicon, is particularly useful. The fifth edition did make some significant changes (in my view, for the better) and all reporting radiologists should be aware of these.
Finally, it is vital to be aware of how the clinical context can alter the significance of the findings. For example, in a patient with a BRCA 1 mutation, a new focus of enhancement should be evaluated very carefully, because cancers in these patients can often appear benign.
Reference
- Vinnicombe S. How I report breast magnetic resonance imaging studies for breast cancer staging and screening. Cancer Imaging. 2016;16(1):17. doi: 10.1186/s40644-016-0078-0
