Preoperative Breast Magnetic Resonance Imaging: An Ontario Health (Cancer Care Ontario) Clinical Practice Guideline

Sep 24, 2026

Preoperative breast magnetic resonance imaging (MRI) use after breast cancer diagnosis by mammography and/or ultrasound is inconsistent. A systematic review and meta-analysis were used to support reconvening a clinical practice guideline. Evidence indicates MRI can improve recurrence outcomes, reduce reoperation rates, and increase detection of synchronous contralateral breast cancer. Recommendations are case-by-case, with stronger guidance for invasive lobular carcinoma, incorporating shared decision-making on MRI benefits, risks, and patient preferences, including specific indications for surgical planning and lesion identification.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages16

Reading Time40 min

AccessFree to download

Introduction

Clinical context and diagnostic workflow

Rationale for contrast-enhanced breast MRI

Guidelines Preoperative Breast Magnetic Resonance Imaging: An Ontario Health (Cancer Care Ontario) Clinical Practice Guideline Derek Muradali 1,*, Glenn G. Fletcher 2, Erin Cordeiro 3, Samantha Fienberg 4, Ralph George 5, Supriya Kulkarni 1, Jean M. Seely 6, Rola Shaheen 7,8 and Andrea Eisen 9, * Citation: Muradali, D.; Fletcher, G.G.; Cordeiro, E.; Fienberg, S.; George, R.; Kulkarni, S.; Seely, J.M.; Shaheen, R.; Eisen, A. Preoperative Breast Magnetic Resonance Imaging: An Ontario Health (Cancer Care Ontario) Clinical Practice Guideline. Curr. Oncol. 2023, 30, 6255–6270 . [https://doi.org/10.3390/](https://doi.org/10.3390/)[ ](https://doi.org/10.3390/)curroncol30070463 Received: 12 May 2023 Revised: 23 June 2023 Accepted: 28 June 2023 Published: 30 June 2023 Copyright: © 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ([https://](https://)[ ](https://)[creativecommons.org/licenses/by/](creativecommons.org/licenses/by/)[ ](creativecommons.org/licenses/by/)[4.0/](4.0/)) . 1 Department of Medical Imaging, University of Toronto, Toronto, ON M5T 1W7, Canada; [supriya.kulkarni@uhn.ca](supriya.kulkarni@uhn.ca) 2 Program in Evidence-Based Care, Department of Oncology, McMaster University, Hamilton, ON L8S 4L8, Canada; gﬂ[etche@mcmaster.ca](etche@mcmaster.ca) 3 Department of Surgery, University of Ottawa, Ottawa, ON K1N 6N5, Canada; [ecordeiro@toh.ca](ecordeiro@toh.ca) 4 Ontario Health (Cancer Care Ontario), Toronto, ON M5G 2L3, Canada; samantha.ﬁ[enberg@ontariohealth.ca](enberg@ontariohealth.ca) 5 Department of Surgery, University of Toronto, Toronto, ON M5T 1P5, Canada; [ralph.george@unityhealth.to](ralph.george@unityhealth.to) 6 Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa, ON K1N 6N5, Canada; [jeseely@toh.ca](jeseely@toh.ca) 7 Department of Radiology, Queen's University, Kingston, ON K7L 3N6, Canada; [rshaheen@prhc.on.ca](rshaheen@prhc.on.ca) 8 Diagnostic Imaging, Peterborough Regional Health Centre, Peterborough, ON K9J 7C6, Canada 9 Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada * Correspondence: [derek.muradali@unityhealth.to](derek.muradali@unityhealth.to) (D.M.); [andrea.eisen@sunnybrook.ca](andrea.eisen@sunnybrook.ca) (A.E.) Abstract: Background: The use of preoperative breast magnetic resonance imaging (MRI) after the diagnosis of breast cancer by mammography and/or ultrasound is inconsistent. Methods: After conducting a systematic review and meta-analysis comparing preoperative breast MRI versus no MRI, we reconvened to prepare a clinical practice guideline on this topic. Results: Based on the evidence that MRI improved recurrence, decreased the rates of reoperations (re-excisions or conversion mastectomy), and increased detection of synchronous contralateral breast cancer, we recommend that preoperative breast MRI should be considered on a case-by-case basis in patients diagnosed with breast cancer for whom additional information about disease extent could inﬂuence treatment. Based on stronger evidence, preoperative breast MRI is recommended in patients diagnosed with invasive lobular carcinoma for whom additional information about disease extent could inﬂuence treatment. For both recommendations, the decision to proceed with MRI would be conditional on shared decision-making between care providers and the patient, taking into account the beneﬁts and risks of MRI as well as patient preferences. Based on the opinion of the Working Group, preoperative breast MRI is also recommended in the following more speciﬁc situations: (a) to aid in surgical planning of breast conserving surgery in patients with suspected or known multicentric or multifocal disease;(b) to identify additional lesions in patients with dense breasts; (c) to determine the presence o

FAQs

Why is preoperative breast MRI after diagnosis currently inconsistent?

Preoperative breast MRI use varies because the decision is not standardized, despite MRI being widely used to characterize disease extent. The guideline addresses this inconsistency by consolidating evidence into practice recommendations.

When should preoperative breast MRI be considered based on the guideline?

The guideline recommends considering preoperative breast MRI on a case-by-case basis when additional information about disease extent could influence treatment. For invasive lobular carcinoma, preoperative breast MRI is recommended with stronger supporting evidence.

What role does shared decision-making play?

Proceeding with MRI should be conditional on shared decision-making between care providers and the patient. The discussion should weigh MRI benefits and risks and reflect patient preferences.

Sep 24, 2026

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