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Pre-Operative Breast MRI

Pre-Operative Breast MRI. Kathy Schilling, MD Center for Breast Care Boca Raton Community Hospital. Case 1. 58 year old woman with indeterminant calcifications central right breast. Fatty Enbloc procedure: DCIS

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Pre-Operative Breast MRI

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  1. Pre-Operative Breast MRI Kathy Schilling, MD Center for Breast Care Boca Raton Community Hospital

  2. Case 1 • 58 year old woman with indeterminant calcifications central right breast. Fatty • Enbloc procedure: DCIS • MRI: biopsy cavity with 2cm enhancement posteriorly suspicious for invasive disease • Surgery: IDC, negative sentinel nodes

  3. Points • MRI can better predict the extent of disease than mammography even in the fatty breast • Surgical management may change as a result of pre-operative MRI: sentinel node was performed preventing second surgery, wide localization performed appropriately to avoid positive margins

  4. Case 2 • The patient is a 69 year old woman presenting with a 2 cm left axillary mass found to be adenoCA compatible with breast primary. Negative prior mammogram • MRI identified 2 small suspicious masses in the UOQ

  5. Case 2 cont’d • Diagnostic mammogram & US demonstrated 2 spiculated solid masses which corresponded • US core biopsy found 2 IDLC • Lumpectomy and axillary dissection was performed

  6. Points • MRI is valuable in the evaluation of a patient with axillary disease with unknown breast primary • Targeted mammography and US performed after MRI will often identify abnormalities which then can be biopsied with US or stereotactic guidance

  7. Case 3 • 43 year old woman found to have calcifications on baseline preoperative mammogram • Stereotactic biopsy found IDC • MRI found 7 suspicious breast masses • Bilateral mastectomy with reconstruction was performed

  8. Points • Mammography may underestimate the extent of disease which is easily detected on MRI • The patient may be prevented from developing recurrent disease with preoperative MRI

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