The fight against breast cancer in Trinidad and Tobago has received welcome news with the launch of the first local Breast MRI service offering MRI guided biopsies with Computer Aided Detection. This new service is being provided by MRI of Trinidad and Tobago which is located next to the Hasley Crawford Stadium. MRI of Trinidad and Tobago is the longest established MRI centre in Port-of-Spain and is celebrating its 15 year anniversary since its opening in 1997.
MRI scanning is a modern imaging technique developed in the 1980s that has literally transformed medicine by providing high resolution detailed imaging of the internal structures of the body. Among the important features of MRI scanning is that, unlike x-rays, it does not use harmful radiation and also it produces much clearer images of the soft tissue structures within the body.
These two features of MRI imaging, along with several recent advances in MRI equipment, techniques and dedicated software have resulted in MRI becoming a revolutionary tool for the earlier detection, accurate staging and precise treatment planning of breast cancer.
It is a fact that modern Breast MRI is currently the most sensitive imaging technique for detecting abnormalities in the breast. As such, Breast MRI is able to detect many breast tumours that cannot be seen with mammography or ultrasound which are the conventional imaging techniques used for breast imaging.
It is important to know that a diagnosis of cancer can only be definitely confirmed by taking a sample of the suspicious area seen on imaging and testing it under a microscope. The procedure for taking a sample is called a biopsy. Since MRI is able to see abnormalities that are not visible with other imaging techniques, then it is very important that the doctors must also be able to use the MRI scanner to guide the biopsy process, to take the necessary samples for determining whether an abnormality seen on MRI is in fact cancerous.
The launch of the MRI guided Breast biopsy service by MRI of Trinidad and Tobago, is therefore a significant development since there is no other service in Trinidad and Tobago or in the English speaking Caribbean offering this service.
However, in spite of all of the clear benefits of Breast MRI, its relatively high cost as well as its extremely high sensitivity limits its use as a primary test for breast cancer screening. X-ray Mammography remains the test of choice in the routine breast cancer screening of women.
Breast MRI is instead used in certain defined cases as an advanced higher level diagnostic tool to give additional information, beyond that provided by the basic tests of mammography and ultrasound. The current American College of Radiology guidelines recommend that Breast MRI be used in the following situations:
1. In patients at known high risk for breast cancer, for example due to a strong family history or known genetic mutations, it is used as a more sensitive screening tool.
2. In patients with dense breast tissue who are not easily imaged with mammography, or in cases where the mammogram is inconclusive.
3. In cases of newly diagnosed breast cancer, it is used to determine the exact extent of the disease, so as to clearly guide treatment decisions such as, whether to just remove the lump or perform a complete mastectomy.
4. It is used in some cases to monitor the tumour response to chemotherapy.
5. It is also used in some cases after the removal of a lump, to distinguish scar tissue from cancer recurrence.
6. It is also recommended in patients with breast implants, to ensure that the implant has not ruptured or to evaluate the breast tissue for any abnormalities.
Breast MRI produces hundreds of images which must be interpreted by the doctor called a Radiologist, in making the diagnosis. In order to assist the Radiologist, high powered computers and software have been developed to process the MRI images and improve the accuracy of the MRI scan. This post processing technique is called Computer Aided Detection. The same software is also used to provide 3D guidance for the Radiologist to perform a more accurate biopsy of suspicious tissue. MRI of Trinidad and Tobago is the first local centre to utilize MRI Computer Aided Detection and Biopsy Guidance. The breast MRI scans will also be read by an internationally renowned breast MRI Radiologist based in the UK, working with an internationally trained and certified locally based Radiologist to perform the biopsies.
More information on Breast MRI and MRI guided biopsy can be obtained by calling the centre at 623-4674.
