Are we performing breast MRI the wrong way around?

A Brigham and Women’s Hospital study has found evidence that MR imaging should be done both while women are lying face-down and face-up.

Breast MR imaging is traditionally done while women are lying on their fronts. However, a study published today in Radiology has found that tumors are more likely to be completely removed in an operation when tumors when women receive additional MR imaging while lying on their backs – the same position they are in when they are operated on. Radiologist Eva Gombos, the study’s lead author, explains why this seemingly simple proposal could make breast tumor removal far more effective.

ResearchGate: Could you explain the results of your study? What benefits does receiving a breast MRI while lying on their back have for women who require breast surgery?

Eva Gombos: We demonstrated that the usual breast MR imaging, which is taken when the patient is lying face-down, results in considerable deformity of the breast and the tumor position when compared to imaging performed in supine position (when the patient is lying on her back). We found that it may be helpful for surgeons to receive MR images of their patients while they are lying on their backs as this is the surgical position. This would allow them to plan the breast surgery and achieve the removal of an entire tumor in a single operation. This is important as up to 40% of breast cancer surgeries require re-excision.

In our study, in addition to the pre-operative imaging, we performed the MR imaging in the operating room immediately after surgery. This technique could be used in future to check for residual tumors straight after surgery, so they can be removed immediately rather than requiring a second surgery.

RG: What method did you use in your study?

Gombos: We examined what effect the addition of a breast MR during breast cancer surgery while women were lying on their backs had when used in combination with the usual breast MR imaging.

Using software, we segmented the tumor on MR images, and a 3D structure of the tumor was generated. Face-down and lying-on-back contrast-enhanced MR images were superimposed on one another and displayed for the surgeon at the time of surgery. We also did an additional breast MR of the women while they were lying on their backs immediately after their operation to see if we could detect residual tumors.

RG: It seems nonsensical that the MRIs are generally done the wrong way around. Why has this been the case for so long?

Gombos: For diagnostic purposes prone (face-down) breast MRIs are still preferred. This is because this results in better resolution and because a breast coil can be used, which leads to better quality images. Breasts are pendant-shaped, and the hanging down position allows a better visualization of the tissues close to the chest wall and armpit. Therefore, hanging down breasts provide a better approach for MR-guided biopsies.

RG: Have there been studies looking into this in the past?

Gombos: There have been multiple studies that have performed supine breast MR. However, our study differs from the existing studies in multiple ways. We did the study in the operating room during breast cancer surgery, and the superimposed images were displayed for the surgeon at the time of surgery. Also, we did an additional breast MR of the women while lying on their backs immediately after the operation while they were still in the operating room in order to detect residual tumors.

Featured image courtesy of Airman Magazine.