28649 – BREAST MRI IN THE UNIFIED HEALTH SYSTEM (SUS): A THREE-MONTH EXPERIENCE AT THE PORTO ALEGRE CLINICAL HOSPITAL

Abstract

Introduction: Magnetic resonance imaging (MRI) of the breasts is an important tool for screening and diagnosing breast
pathologies, being considered the most sensitive exam for breast cancer, superior to clinical examination, mammography,
and ultrasound, with variable specificity. Although the method has great potential, due to its high cost and low availability,
it remains an underutilized exam within the Unified Health System (SUS). Thanks to its high spatial resolution, multiplanar
capability, and excellent tissue contrast, MRI can be used in the evaluation of various breast conditions. Another benefit
of its use is the absence of ionizing radiation exposure to the patient. Its indications are well established, and routine use
is not recommended. Current indications include screening in high-risk patients for breast cancer, inconclusive imaging
on conventional exams, evaluation of multifocal/multicentric disease, assessment of implants, and post-neoadjuvant
chemotherapy evaluation. Among these, screening high-risk populations for the development of breast cancer stands out
as the indication with the strongest scientific support. Understanding these indications thoroughl y and requesting MRI
judiciously and evidence-based is essential for good practice in Mastology. In this study, we analyzed the main indications and the profile of patients who underwent breast MRI at the Porto Alegre Clinical Hospital (HCPA) during a quarter of 2023. Methodology: This is a cross-sectional study. The indications and profile of patients who underwent breast
MRI between August and November 2023 were analyzed, representing the initial period of implementation of the exam
in the Mastology Department at HCPA. Conclusion: In summary, there is well-established evidence supporting the use
of breast MRI both for screening and diagnosing a variety of breast pathologies. However, this exam remains underutilized in our country due to limited access and lack of awareness about its appropriate indications. It is essential to understand its indications well and request the examination judiciously, as, despite its high sensitivity, the probability of false
positives is also increased. In this study, we observed that, consistent with the most current evidence, the main reason
for ordering the exam at HCPA’s Mastology Department was screening in high-risk populations. Additionally, it is crucial
to have a well-trained team of radiologists with expertise in breast imaging for accurate interpretation of the method.
Furthermore, expanding and integrating breast MRI into the SUS is of utmost importance to ensure comprehensive and
inclusive care for this portion of the population.