Over the last 20 years conservative surgical therapy has become the treatment of choice for the treatment of early operative breast cancer. Although outcomes with conservation therapy are better, there are potential disadvantages such as increased cost, an increased number of operative procedures, and clinically unappreciated extensive disease, which can necessitate eventual mastectomy.

Careful planning based on clinical evidence and mammography has traditionally been the best way to minimize these disadvantages. Despite this, a significant number of women with cancer require multiple breast procedures to obtain clear margins or a repeat axillary procedure for clearance if their sentinel nodes are positive.

Moreover, recurrences or the development of second primary cancers can occur following successful conservative treatment in up to 7% of cancer patients. Many of these second cancers arise soon enough after the diagnosis of the original lesion to suggest the possibility that they were present, but undetectable at the time of the first diagnosis.

Preoperative staging with MRI has been reported in retrospective series to detect additional malignant lesions at the time of diagnosis of a primary malignancy. In over 25% of cases, the prior knowledge of the true extent these malignant lesions would have significantly changed the patient’s surgical plan.  Also, patients surgically treated following MRI staging have been shown to have decreased recurrence rates in the immediate postoperative period.

Whole breast, hand‐held, ultrasound in combination with mammography has also been shown to improve the accuracy of preoperative staging in women with cancer.  The technique requires practice and is generally performed by a physician. A study can require over 45 minutes, especially if there are sonographically visible findings.