Alexander MUNDINGER, Carolin MUNDINGER, Darius DIAN, Thorsten HEILMANN, Shigeru IMOTO, Atilla SORAN, Wendie A BERG, Tolga OZMEN, Mitsuhiro TOZAKI, Katja SIEGMANN-LUZ, Ayfer Kamali POLAT, Salete de Jesus Fonseca RÊGO, Pieter DE VISSCHERE, Sylvia H. HEYWANG-KÖBRUNNER, Dionysios KOUFOUDAKIS, Bolivar ARBOLEDA-OSORIO, Maurício Magalhães COSTA, Tadeusz PIE?KOWSKI, Paula PODOLSKI, Vahit OZMEN, Schlomo SCHNEEBAUM, Constanze ELFGEN, Lydia IOANNIDOU-MOUZAKA, Marianna TELESCA, Manisha BAHL, Makus MÜLLER-SCHIMPFLE, Vaidotas CESNA, Siarhei KHARUZHYK, Carole MATHELIN
European Journal of Breast Health - 2026;22(3):328-339
Objective: To map global practice patterns and disparities in the use of preoperative breast magnetic resonance imaging (MRI) for early breast cancer (EBC) among members of the Senologic International Society (SIS) and SIS Working Group. Materials and Methods: A cross-sectional, web-based survey was distributed to SIS members worldwide. The questionnaire captured respondent demographics, center characteristics, local/national breast MRI use, guideline perceptions and personal practice, specific indications for MRI, and decision-making influences. Results: We analyzed 114 responses from 17 countries. Significant variations were observed. While 36/46 (78.3%) of Japanese respondents perceived national guidelines as recommending preoperative MRI, only 18/60 (30%) of Europeans did. Overall, 96/114 (84.2%) of all respondents believed preoperative MRI provided a patient benefit, with none believing it caused harm. The most frequent indications in the total cohort were invasive lobular carcinoma (106/114, 93.0%), mammographic/sonographic suspicion of multifocality/multicentricity (96/114, 84.2%) and planned neoadjuvant therapy (89/114, 78.1%), while in Japan ductal carcinoma in situ (DCIS) or accompanying DCIS component was the most frequent indication (45/46, 97.8%). Half of respondents stated that national guidelines recommend preoperative breast MRI for EBC (57/114, 50%). Furthermore, 30/57 (52.6%) of these "guideline-positive" respondents reported performing more MRIs than advised while most guidelines recommending only selected preoperative indications such as invasive lobular histopathology, dense breasts, suspicion of multifocality/multicentricity or imaging inconsistencies. Key influencing factors included specialty, reimbursement, and time to access preoperative MRI. Conclusion: This SIS-based international survey revealed heterogeneous global adoption of preoperative breast MRI for EBC, highlighting a significant gap between evidence-based guidelines and real-world practice. Clinical decisions are heavily influenced by geography, culture and resources, and belief in patient benefit. These findings highlight the need to tailor guidelines to local contexts, and strengthen awareness and dissemination efforts, together with further research to clarify the role of MRI in the modern multidisciplinary management of EBC.
