As radiologists we often are focused on the development and application of new modalities that will help us to improve our patients’ lives through earlier and more accurate diagnoses and specifically targeted treatments, and we are always on the lookout for the next best thing that will help us achieve these goals.

MRI is not a new imaging technique, but in the triage of breast cancer patients to appropriate therapy, breast MRI has advantages and important benefits that are highlighted in the July issue of the AJR in an article titled “Breast MRI in the Evaluation of Eligibility for Accelerated Partial Breast Irradiation,” by Juan Godinez and his colleagues.

Breast-conserving therapy, specifically lumpectomy and whole-breast irradiation, has been the treatment of choice for addressing early stage breast cancers in many patients. This option has been further enhanced with the development of accelerated partial breast irradiation which allows for a five-day duration of radiation treatment rather than the usual six weeks.

Yet, while the treatment has demonstrated encouraging early results and may enable treatment for patients who would have difficulty with the six-week whole breast schedule, there are no long-term data and there are no randomized trials comparing accelerated partial breast irradiation with whole-breast radiation therapy. However, based on early results, partial breast irradiation warrants further consideration to determine its true efficacy and role in addressing a diagnosis of breast cancer.

But how do we determine the candidacy of a particular patient for breast conserving therapy with partial breast irradiation? Moreover, how do we confirm that a patient would, in fact, be better advised to undergo a mastectomy to reduce the chances of a breast cancer recurrence?

In times past all we had to rely on was conventional mammography and physical examination to determine which patients should undergo breast-conserving therapy. Now we have many other modalities in the imaging armamentarium, including breast MRI that permit identification of mammographically occult malignancy. MRI can also identify sites of tumor remote from the index lesion. The accurate staging and timely diagnosis of breast cancer is empowered by such information, and helps to guide selection of appropriate therapy. Partial breast irradiation is used in patients with low risk for local recurrence. If remote or multicentric disease is present, patients are likely to be referred for mastectomy.

In the retrospective article by Godinez et al, breast MRI proved useful, finding otherwise occult lesions in 38% of the 79 patients studied as confirmed by final pathology. This study may be the first s in establishing breast MR as a necessary stage in determining patient eligibility for accelerated partial breast irradiation and as a means for identifying patients who might be better served by undergoing a mastectomy.

A recently initiated clinical trial comparing whole-breast radiation therapy with accelerated partial breast irradiation (NSABPB-39/RTOG 0413) should help identify the preferred method of treatment.

If you are involved or interested in women’s imaging, I strongly encourage you to read this article, not only for the insight it offers into the expanded role of MRI in accurate diagnosis and staging, but also for its potential benefits in triaging treatment selection for patients contemplating breast conservation.

We invite all interested parties to offer suggestions, feedback and to participate or contribute to our women’s imaging online community by contacting us at womensimaging@arrs.org.