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Breast magnetic resonance imaging (MRI) is increasingly used in conjunction with mammography as a screening tool to detect breast cancers in asymptomatic high-risk women. Conventional dynamic contrast-enhanced (DCE) breast MRI has a high sensitivity but only moderate specificity for the detection of breast cancer. The primary goal of developing and applying advanced breast MRI techniques that can assess tissue biology is to improve lesion specificity. This review provides a summary of the advances in DCE-MRI techniques and the use of diffusion-weighted imaging and magnetic resonance spectroscopy for breast cancer detection. Publications on the use of these advanced MRI techniques are largely single-institution studies with small numbers of patients, which limits the generalization of this data to a wider screening population. In their current forms, these adjunctive techniques require further research, incorporating an expanded patient population, to validate their utility for breast cancer screening.

Compared with traditional methods of pre-operative localization of non-palpable breast lesions, iodine-125 radioactive seed localization has been shown to provide better patient outcomes, including more accurate localization with smaller specimen size and fewer positive margins. Increased satisfaction of patients, surgeons, and radiologists is also demonstrated when radioactive seeds are employed for localization. This article begins with a comprehensive review of the literature regarding the evolution of this increasingly utilized technique and then emphasizes the key points to develop and maintain a successful radioactive seed localization program. Insertion of radioactive seeds for breast localization purposes requires special considerations before, during, and after the procedure, which will be highlighted in addition to practical advice for accurate seed placement.