"Breast Care" - Reduced Journal Subscription for EUSOBI members
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Breast MIR International Course in Florence/IT
by F. Sardanelli, Milan/IT
On October 27, the first Breast MRI International Course was held in Florence, presided by F. Sardanelli (Milan) and J. Nori (Florence) and supported by EUSOBI, the University of Florence, and the Breast Imaging Section of the Italian Society of Radiology, attended by over 230 participants. Leading breast radiologists discussed image interpretation and clinical issues of breast MRI as well as latest advances in breast MR-guided intervention and new MR techniques. At the beginning of the meeting, F. Sardanelli underlined that "while we have the perception of a faster and faster technical evolution, more than twenty years passed from 1986, when S. Heywang-Kobrunner published on the JCAT the first report on contrast-enhanced MRI of the breast. Thus, only in the last years we are at the real take-off of this technique in breast imaging. The clinical penetrance of a new technique is a relatively long process, especially when other approaches are well established and cover both screening and diagnosis as it was for mammography, ultrasound and imaging-guided biopsy".
The first part of the meeting regarded breast MR image interpretation. E. Morris, D. Dershaw and R. Wynn (New York) underlined the need to follow standardized classification and algorithms for lesion assessment, in particular the BI-RADS classification on the basis of morphological and kinetic findings. Considering potential problems and limitations, a practical "soft" method to manage an MRI examination of the breast using a PACS system was deeply explained.
The second and the third parts of the course concerned clinical issues. The role of breast MRI in the local staging of breast cancer was extensively illustrated by E.Morris, C. Kuhl (Bonn University), and C. Boetes (Nijimegen). The speakers described the better performance of breast MRI in comparison with conventional Imaging (mammography and ultrasounds) in the evaluation of local extent of both invasive and in situ cancers and in the identification of synchronous contralateral cancers. They described a potential reduction of local relapses as a consequence of the introduction of preoperative breast MRI. C. Boetes underlined that breast MRI allows a correct change of surgical treatment in the majority of the cases but she suggested that results of randomized trials are requested in order to assess if the application of breast MRI may positively influence the patient's outcome. V Sacchini (New York), reported the surgeon's opinions, including potential surgical overtreatment due to the inappropriate use of breast MRI. M. Bazzocchi (Udine) illustrated the results of a study performed in his Department, concerning the role of breast MRI in the management of women with borderline lesions diagnosed at core-needle biopsy. The Authors concluded that the high negative predictive value of breast MRI might help in the diagnostic work up of this lesions, avoiding unnecessary surgical biopsies. The possibility to assess and predict the tumoral response to neoadjuvant chemotherapy by variation of morphological and functional features at breast MRI was illustrated by A. Tardivon (Paris) while F. Sardanelli outlined the role of breast MR in the surveillance of women at high-genetic-familial risk of breast cancer. P. Panizza (Milan) described the ability of breast MRI to detect the primary carcinoma in patients with metastasis and negative either clinical examination or conventional imaging (CUP syndrome). A statement by C. Kuhl summarized the sessions dedicated to clinical issues: "See the patient and decide. Treat breast MRI as a friend and not as an enemy".
The last session of the course was started by a lecture by S. Heywang-Kobrunner (Munich), illustrating the history of breast MRI from the first study performed and the first prototype of breast coil made to the nowadays research and clinical applications. "Significant progress has been made. MRI has an established role in breast imaging and new possibilities exist in all field" she said. However, she added that breast MRI is not for everyone in every clinical situation. There is not indication in performing the examination either in asymptomatic patients with dense tissue or in cases that are solvable by percutaneous biopsy. Practical advices and potential pitfalls and limitations in performing MR-guided breast interventions were illustrated by R. Winn while the two last lectures, provided by L. Martincich (Candiolo, Turin) and A. Fausto (Milan) concerned the potential clinical applications of two new breast MR techniques: diffusion-weighted imaging and proton spectroscopy. Both the techniques, reflecting some biological aspects of breast cancer, are promising tools potentially able to improve the specificity of breast MRI and to early assess the tumoral response to medical treatment.
At the end of meeting F. Sardanelli asked S. Heywang-Kobrunner whether in 1986 she suspected that contrast-enhanced breast MR could gain the role which today is on the clinical scenario. She admitted that this development was unpredictable and that a particular combination of circumstances determined her choice to run this new way. As frequently happens in the history of clinical sciences, only the time is able to show the reliability of a new approach.
L. Martincich and J. Nori
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EUSOBI Breast Imaging Update 2006 - ECR 2006 newstyle special
Digital mammography and MR guidance promise new horizons at ECR’s back-to-back meeting
by Th. Helbich, Vienna/AT
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Current and future development in Digital mammography
by R. Schulz-Wendtland
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