In which patients do you utilize a breast MRI as part of the initial workup for breast cancer?

I'm not a fan of routine MRI in the work-up for early-stage breast cancer, but I do agree with the fairly standard list of selective indications mentioned previously.

I also obtain an MRI when there is a significant discrepancy between standard imaging and physical exam. Examples would be:

1. One or a...

Usually, for us, it is done for lobular pathology, locally advanced breast cancer, or dense breast tissue.

We recently endorsed and expanded upon the Cancer Care Ontario (CCO) list of indications for pre-operative breast MRI in a modified Delphi consensus of expert opinion Cao et al., PMID 39590163

Preoperative breast MRI was recommended in the following situations:

• In patients diagnosed with invasive lob...

MRI discovers a second focus in 15-30% of patients. I try to use MRI often in my patients to aid in surgical and radiation treatment planning. At least 50% of the lesions detected are biopsy positive.