Technologies in Breast Cancer... Video Transcript

Participants

Christine Haran , Mitchell Schnall MD, PhD, Carol L. Kornmehl MD, FACRO

Summary

Although Magnetic Resonance Imaging has been used as a powerful tool in other fields for several years, its use for diagnosing breast cancer is a new development. Today, there is an increasing role for breast MRI in certain patients.

Webcast Transcript

MITCHELL SCHNALL, MD: My name is Dr. Mitchell Schnall. I'm an Associate Professor of Radiology at the University of Pennsylvania and today we're going to talk about MRI for the diagnosis and detection of breast cancer.

MRI stands for Magnetic Resonance Imaging. It's very different from X-ray. It actually uses magnetic fields and the magnetic properties of the body to image various atoms and molecules in the body. And for the most part what we take images of are water and fat.

There have been a number of suggested uses of MRI for imaging the breast. The area that so far has been shown to be most fruitful and that you see breast MRI being used in routine clinical practice is in the determination of the extent of breast cancer. In patients who have breast cancer, the extent of the disease can be very important to determine whether they are a candidate for a lumpectomy, for example. Or what kind of mastectomy, how aggressive a mastectomy needs to be performed.

What MRI can allow us to do is to uniquely identify the full extent of the cancer, much more accurately than the techniques we have. So those decisions can be made appropriately.

For breast MRI we would always use what we call a contrast agent. A contrast agent acts like a dye to stain an area of the image so that you can see that area better. And by its delivery to an area of the body, it changes the way it looks with MRI.

Tumors in the breast tend to have a lot more blood supply than the normal breast tissue because they're growing quickly. The contrast agent we give, gadolinium, will go to where the blood vessels are. So it tends to allow us to see the tumors because of their high vascularity.

When a woman arrives to have a breast MRI exam, the first thing that happens is what happens with every MRI exam, and that is, they undergo some screening to make sure that they don't have anything in their body that would make an MRI exam unsafe. They don't have metallic implants that are magnetic. Women with pacemakers would not be appropriate to have an MRI, and other things.

The largest part of the MR machine is the magnetic that the woman is placed into. Most of these magnets looks to some extent like a tunnel. That's because there's a coil that's wound, essentially around the tunnel, which makes the magnetic field. What we refer to as coils, which are the antennas that pick up the radio waves from the body, will be placed in and around the breast.

And then the woman would be placed into the bore of the MR magnet, lying on her stomach with the coils around her breast.

TECHNICIAN: You doing okay?

WOMAN PATIENT: Hmmm.

TECHNICIAN: Great. Just setting up your next scan.

MITCHELL SCHNALL, MD: Some images would be made before contrast. Contrast would then be injected and images would be made after contrast. The entire procedure usually will last between 20 and 30 minutes.

WOMAN PATIENT: I came here for an MRI today because I had a needle localization. I had carcinoma in situ in the left breast and they decided first of all I should have an MRI and then later this afternoon, I'm having another mammography.

You lie face down. You hear all these clicking sounds. It's just basically being very still and very quiet. And everybody was so nice and they talked to me and got me through it without any problem whatsoever.

MITCHELL SCHNALL, MD: This is a pre-contrast image of a woman who originally came to see her doctor because she had a lump under her armpit, or in the axilla. A biopsy of that lump was performed and it revealed that it was cancer.

Unfortunately her mammogram was normal.