Unfortunately, mammograms miss 20-25% of all cancers. They also underestimate the size of DCIS in a third of all lumpectomy patients. When this happens, the surgeon misses some DCIS and another surgery is needed. MRIs, which use magnets rather than radiation, can find what mammograms miss.
According to a new study published in Academic Radiology in 2018, performing MRI on patients with non-invasive breast cancer can provide additional value.
The authors studied data from 295 patients with ductal carcinoma in situ (DCIS), focusing on 123 patients who received both mammography and breast MRI. The mean patient age was 57 years old. The mean tumor size was 39.6 mm.
Overall, the DCIS was clinically occult in the mammography results for more than 24 percent of patients. DCIS was clinically occult in more than 1 percent of the breast MRI results.
Conclusion
MRI outperforms MG in the detection and size estimation of DCIS and can reduce positive margin rates.
According to a 2010 JNCI article by Dr. Constance Lehman: “Over the last decade, research has confirmed that of all imaging tools, MRI has the highest sensitivity in detection of DCIS (compared with mammography and ultrasound).” This is especially true of the more aggressive high grade DCIS. A 2007 study by University of Bonn radiologist Professor Christiane Kuhl found that MRI detected 98% of high grade DCIS while mammography found only 52%. According to her, this is because high grade DCIS does not develop the micro calcifications that mammograms detect, but instead develops blood vessels which absorb the contrast dye used in an MRI. Dr. Kuhl’s most recent study demonstrated that a shorter and possibly less expensive breast (FAST ) MRI protocol seems to be just as accurate and far less expensive.
In 1996, a small study concluded: RODEO MR imaging enabled accurate determination of tumor extent in 21 of 22 (95%) patients. Mammography depicted 18 of 19 DCIS lesions. No mammographic feature helped differentiate pure DCIS from DCIS with micro-invasion. Mammography enabled accurate determination of tumor extent in 14 of 19 (74%) patients. See Abstract here.
The Aurora RODEO MRI offered at 35 locations in the United States, is a dedicated MRI, meaning it is used only for breast imaging. Its unique technology provides sharper 3-D images and better resolution than a standard whole body MRI. According to Dr. Steven Harms, referring to the RODEO MRI in a 2006 interview for Radiology Today, “We get three times the signal-to-noise ratio (SNR) of most 3DFT images. We’re using that SNR to improve resolution and improve the contrast resolution. And there are significant gains in both of those. The image resolution by the number of voxels we generate is three times that of what we had before. We also reduce scan time, which is less than half of what it was and contrast is about twice what it was before. It’s a considerable gain.”
In fact, a 2012 study by Dr. Bruce J. Hillman etal showed that, while the false negative rate for whole body MRI has historically averaged 15%, the false negative rate for the RODEO MRI is less than 1%. In other words, if a RODEO MRI finds no cancer, there is only a 1% chance that it missed something, while with whole body MRI there is still a 15% chance cancer was missed. This study also showed that while whole body MRI has been criticized for its high false positive rates, typically between 32 and 41%, RODEO MRI has a very low false positive rate of only 11%. This means if a RODEO MRI finds something suspicious, the chances of an unnecessary biopsy are much lower.
With such good numbers, the Aurora RODEO MRI is a highly accurate and useful imaging tool, especially for DCIS. With its 1% false negative rate, it can provide peace of mind as an annual screening device for higher risk patients. Its accurate 3-D mapping can also assist surgeons in providing more tailored excisions and biopsies of DCIS that cannot be seen on a mammogram, while its low 11% false positive rate protects patients from unnecessary biopsies.
More information about Aurora 1.5T Dedicated Breast MRI System here.
Also see: Dedicated breast MRI reins in false positives
*According to Dr. Michael Lagios, any “dedicated” breast MRI is as effective as an Aurora RODEO MRI. This means the MRI machine is used exclusively for breast imaging and is not used to image other body parts. Just like mammography is used at breast imaging centers strictly for breast imaging.
DCIS Redefined 
Did you have gadolinium used as a contrast or does the Rodeo MRI work without contrast?
Hi Dawn,
Great question and one that also concerns me. Unfortunately this is the downside to even the RODEO MRI. I do not know if it is possible to do the MRI without the gadolinium, but I think this is what helps to see if there is any cancer. Probably wise to do a mild detox after an MRI. I went for a run a few hours after an MRI and I felt really weak. Some good info here on detoxification of heavy metals. Scroll down to “Step 1: Getting Ready for Detoxification”: http://drhyman.com/blog/2010/05/19/how-to-rid-your-body-of-mercury-and-other-heavy-metals-a-3-step-plan-to-recover-your-health/#close
Dear Dawn,
Solutions of chelated organic gadolinium based complex agents (GBCAs) are used as intravenously administered gadolinium-based MRI contrast agents in medical magnetic resonance imaging for both standard and RODEO MRIs.
At this time, only a very small percentage of patients who receive GBCAs appear to be at an increased risk for developing a serious systemic fibrosing disease, NSF. The patients at risk are those with acute or chronic severe renal (kidney) insufficiency (glomerular filtration rate < 30 mL/min/1.73m2. They do a blood test prior to all MRIs to make sure a patient's kidneys are functioning well.
When I asked Dr. Harms re this, he said that gadolinium contrast has caused kidney failure in only a very few people worldwide and only if they already were experiencing renal failure. As with any medical procedure the risks need to be weighed vs.the benefits. According to Dr. Harms the risk of using the gadolinium contrast dye is extremely low.
Hope this helps ease your mind.
Hi, I had a mammogram in February that showed very, very small microcalcifications. It was my first mammo. I was naturally referred to have a biopsy. I was not ready to rush into a biopsy. From there is went and had a thermogram which came out clean. Due to my mom have bc twice I was still feeling a little uneasy. I went in for the aurora rodeo MRI in early April. The findings were that there “was no discrete suspicious findings in the area of mammographic concern. Do you have any thoughts on why or how a mammo would pick up calcs and a MRI wouldn’t? It is my understanding that the MRI is more sensitive. In the back of my mind I keep thinking the calcs on the mammo could be scar tissue as they are in the exact location as I had mastitis in. On one hand I feel relief, on the other I am wondering if I should have my mammo (which has already had 2 opinions) and the MRI sent for another opinion? As I mentioned I am in no hurry to get a biopsy, that is my last resort!
Hi Dawn,
If you feel uneasy, it is a good idea to have the microcalcs checked out further. In 2009 I had similar findings on the first mammogram I had after my 2007 lumpectomy for DCIS. They thought they saw some new micro calcs and also two other suspicious areas on an ultrasound. They wanted to do 3 biopsies, yet my RODEO MRI found nothing. In spite of the fact that the RODEO MRI has less than a 1 percent false negative rate, I needed reassurance.
After reading a 2009 October article by Katherine Hobson in U.S. News and World Report, where Dr. Laura Esserman said, “low-risk calcifications need not be biopsied,” I emailed Dr. Laura Esserman. She emailed me this advice: “The key is whether these are new for sure. If they have been present and are stable, then you can probably do close follow up (check in 6 months). So, getting a more precise risk estimate from the radiologists, and finding out whether they are new from prior exams is the key. Also, it is important to make sure that the calcifications are not just showing up because your screens have switched from film screen to digital exams.”
I also contacted the doctor who invented the RODEO MRI, Dr. Steven Harms. He reviewed all my imaging and said he did not see anything invasive. He also said having the 3 biopsies would cause significant scarring and even if he did the biopsies, he would recommend I have another MRI in 6 months. I opted to skip the biopsies and instead have the the 6 month followup MRI. It showed no change and I was therefore able to avoid all 3 biopsies.
That was five years ago and so far my yearly RODEO MRIs have all been good.
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Where are the 35 Aurora Rodeo MRI machines in the US – I am searching for one close to New Orleans, LA
Hi Kathleen, Unfortunately the Aurora website has been down for a while….We recently learned that Aurora may be in bankruptcy. Dr. Lagios said that any “dedicated” breast MRI is equivalent. I would call around to major University hospitals and imaging centers and ask if they have an MRI machine dedicated soley for breast imaging. If they tell you they have a “dedicated” breast coil that is not the same. the machine has to be only used for breast imaging to be considered a truly “dedicated” breast MRI. .
Thanks for sharing I am Dcis Er Pr+++ clear margains Dcis 39 I was almost 40 now at 42 , I am ok , I really can’t stand having the Mammograms since 35! Baseline and the cystic dense breasts that many women have . And ultra sound . Ended up seeing a breast Specialist and was in fear cause my “age” they said m-f rad to the right side . Having tattoos anyways , I didn’t like the 8 dots of tattoos I had to have for the high tech radiation that made me so fatigued and upset somwdays . But I can’t look back I was also told to have the brac1-2 and that was 3-4 weeks wait was ok and I was negative . So I declined tomaxafin Dcis 0 grade 2 clear margains and rads and oncologist was ok w my decision. I have very little animal product and try to eat organic . So , can I have this MRI done next Oct? when I am due for mammo and ultrasound ? I too had the barbed wire and so sorry u has to deal w that barbaric ! To say the least. My reg Dr said they simply don’t have enough data yet who’s immune will fight it and who’s won’t because I was miffed and asked why all cancers invasive or not treated same . So that was what he told me . Hello, not the team of cancer Drs and don’t get me wrong , some were amazing . Anyways ty and do most INsurance co cover this ? Ty so so much for story and ty in advance . Suzie any other tips ?