Mammograms and ultrasound are on the frontline of early breast cancer detection, but a recent study shows Magnetic Resonance Imaging (MRI) should play a stronger role. Newer MRI tools can reveal tumors missed by standard screening methods.

In the fall of 2005, Marlyn Smith had what she thought was an infected bug bite on her right breast. She played it safe and had it checked.

"We did a mammogram, ultrasound and they both came back negative," Smith said.

Still, the condition grew worse. Smith had inflammatory breast cancer, a rare but aggressive form of the dieases often missed by standard screening methods. She did not know it was cancer until three months later when she came to Wake Radiology for an MRI.

"It was overwhelming. When I first saw it, it showed all the cancer," Smith said.

Dr. Glenn Coates said an MRI is too expensive to replace mammograms and ultrasound and he said they are still effective tools for early detection, but a recent study in the New England Journal of Medicine shows that for women who have a positive needle biopsy, more detailed imaging is needed.

"Those patients should all have an MRI before therapy and the treatment is designed," Coates said.

In about 1 out of 10 cases where standard screening diagnosed cancer in one breast, MRI found early stage cancer in the other. The MRI equipment at Wake Radiology has other advantages. They're one of the few centers in the state able to look at the breast scans in three dimensions.

"As you can see, I can grab the 3D model and turn it around in space," said Dr. Coates, as he used the computer screen cursor guided by a desk top mouse.

From the flat two-dimensional view, one tumor measured two centimeters. However, that measurement is true only from one perspective. A three-dimensional image showed another view.

"The tumor is actually 5-1/2 centimeters in size," Coates said.

The 3-D view also reveals several satellite tumors hidden in the previous 2-D image. Coates said radiologists can correctly interpret a tumor's true size through two dimensional images, as they move through the different "slices" of images provided by MRI.

However, Coates said the ability to enhance the image in a 3-D perspective is useful to both the patient in understanding their disease and to the surgeon who can use the information to better plan the surgery.

A better understanding of the staging of the disease also helps determine treatment.

"So this patient is better served by mastectomy than lumpectomy," Coates said.  referring to the same 5 and a half centimeter tumor.

Marlyn Smith had surgery to remove the breast and several lymph nodes. She had radiation and is near the end of her schedule of chemotherapy treatments. She said when the symptoms first appeared, she knew something was wrong, even though the early tests were negative. Other women, she said, should trust their instincts and get a second or third opinion.

"And then ask for the tests that are available. Why not? It could save you your life," said Smith.

Most insurance providers will cover MRI costs if there is a positive needle biopsy. Most will also cover an MRI test, even if standard screening is negative, but the symptoms concern the patient and their doctor.