Letters To The Editor

Radiologic workup of a palpable breast mass

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To the Editor: Thank you for the excellent review, “ The radiologic workup of a palpable breast mass ” in your March 2009 issue. 1

The authors stated that magnetic resonance imaging (MRI) of the breast “does not currently have a role in the workup of a palpable abnormality.” This may be true in general, because breast MRI is more expensive than mammography plus or minus ultrasonography. However, breast surgeons are currently ordering preoperative MRI to evaluate biopsy-proven breast cancer to help them plan the surgery. This is because MRI provides superior three-dimensional spatial resolution and image quality as compared with ultrasonography or mammography.

My question is whether breast MRI might be useful in the prebiopsy diagnostic workup of breast masses in special cases. For example, some women have very sensitive breasts and refuse to undergo mammography, which requires compression of the breast. Another special case is when the palpable mass is located in a portion of the breast which is not amenable to mammography, such as in the axillary tail of the breast. In these cases, MRI might be helpful if the palpable mass is not definitively imaged with ultrasonography. Would the authors care to comment?

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