Additional evaluation of clinical or imaging findings
a. Recurrence of breast cancer – Breast MRI may be useful in women with a prior history of breast cancer and suspicion of recurrence when clinical, mammographic, and/or sonographic findings are inconclusive.
b. Metastatic cancer when the primary is unknown and suspected to be of breast origin – MRI may be useful in patients presenting with metastatic disease and/or axillary adenopathy and no mammographic or physical findings of primary breast carcinoma. Clinical trials demonstrate that breast MRI can locate primary tumor in the breast in over half of women presenting with metastatic axillary adenopathy and an occult primary [27-30]. Breast MRI can also define the disease extent to facilitate treatment planning.
c. Lesion characterization – In rare cases, breast MRI may be indicated when other imaging examinations, such as ultrasound and mammography, and physical examination are inconclusive for the presence of breast cancer, and biopsy cannot be performed (e.g., possible distortion on only one mammographic view without a sonographic correlate). MRI should not replace ultrasound or diagnostic mammography to evaluate clinical focal signs or symptoms in the breast or to evaluate lesions identified on screening mammography [31].
d. Postoperative tissue reconstruction – Breast MRI may be useful in the evaluation of suspected cancer recurrence in patients with tissue transfer flaps.
e. MRI-guided biopsy – MRI is indicated for guidance of interventional procedures such as vacuum assisted biopsy and preoperative wire localization for lesions that are occult on mammography or sonography and demonstrable only with MRI.