MR imaging-guided 10-gauge vacuum-assisted breast biopsy: histological characterisation.
ABSTRACT The aim of this study was to evaluate a handheld vacuum-assisted device for magnetic resonance imaging (MRI)-guided breast biopsy.
In 47 patients, a total of 47 suspicious breast lesions (mean maximum diameter 9 mm) seen with MRI (no suspicious changes on breast ultrasound or mammography) were sampled using a 10-gauge vacuum-assisted breast biopsy (VAB) device under MRI guidance. Histology of biopsy specimens was compared with final histology after surgery or with follow-up in benign lesions.
Technical success was achieved in all biopsies. Histological results from VAB revealed malignancy in 15 lesions (32%), atypical ductal hyperplasia in four lesions (8%) and benign findings in 28 lesions (60%). One of four lesions with atypical ductal hyperplasia was upgraded to ductal carcinoma in situ after surgery. One of seven lesions showing ductal carcinoma was upgraded to invasive carcinoma after surgery. Two lesions diagnosed as infiltrating carcinoma by VAB were not validated at excisional biopsy due to complete removal of the lesion during the procedure. During the follow-up (mean 18 months) of histologically benign lesions, we observed no cases of breast cancer development. Because of morphological changes on follow-up MRI scans, two lesions underwent surgical excision, which confirmed their benign nature. Besides minor complications (massive bleeding, n = 1) requiring no further therapeutic intervention, no complications occurred.
MRI-guided biopsy of breast lesions using a handheld vacuum-assisted device is a safe and effective method for the workup of suspicious lesions seen on breast MRI alone.
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ABSTRACT: OBJECTIVE. The purposes of this study were to determine the frequency of underestimation of high-risk lesions at MRI-guided 9-gauge vacuum-assisted breast biopsy and to determine the imaging and demographic characteristics predictive of lesion upgrade after surgery. MATERIALS AND METHODS. We retrospectively reviewed consecutively detected lesions that were found only at MRI and biopsied under MRI guidance from May 2007 to April 2012. Imaging indications, imaging features, and histologic findings were reviewed. The Fisher exact test was used to assess the association between characteristics and lesion upgrade. Patients lost to follow-up or who underwent mastectomy were excluded, making the final study cohort 140 women with 151 high-risk lesions, 147 of which were excised. RESULTS. A database search yielded the records of 1145 lesions in 1003 women. Biopsy yielded 252 (22.0%) malignant tumors, 184 (16.1%) high-risk lesions, and 709 (61.9%) benign lesions. Thirty of the 147 (20.4%) excised high-risk lesions were upgraded to malignancy. The upgrade rate was highest for atypical ductal hyperplasia, lobular carcinoma in situ, and radial scar. No imaging features were predictive of upgrade. However, there was a significantly higher risk that a high-risk lesion would be upgraded to malignancy if the current MRI-detected high-risk lesion was in the same breast as a malignant tumor previously identified in the remote history, a recently diagnosed malignant tumor, or a high-risk lesion previously identified in the remote history (p = 0.0001). The upgrade rate was significantly higher for women with a personal cancer history than for other indications combined (p = 0.0114). CONCLUSION. The rate of underestimation of malignancy in our series was 20%. No specific imaging features were seen in upgraded cases. Surgical excision is recommended for high-risk lesions found at MRI biopsy and may be particularly warranted for women with a personal history of breast cancer.American Journal of Roentgenology 01/2014; 202(1):237-45. DOI:10.2214/AJR.13.10600 · 2.74 Impact Factor
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ABSTRACT: To determine the utility of short-interval follow-up after benign concordant MRI-guided breast biopsy. Institutional review board approved, retrospective review of consecutive biopsies performed over 3 years (2007-10) yielded 170 women with 188 lesions that were considered benign concordant. Indication for original study, biopsy results, follow-up recommendations, compliance and outcomes of subsequent MRI and mammography examinations were reviewed. The most common indication for breast MRI was high-risk screening 119/170 (70 %). Overall, 59 % of lesions (113/188) had follow-up MRI. Of those lesions (n = 113), 43 % (49/113) presented within 7 months, 26 % (29/113) presented within 8-13 months, 11.5 % (13/113) presented within 14-22 months, and 19 % (22/113) presented after 23 months. At initial follow-up, 37 % of lesions were stable and 61 % were decreased in size. Three lesions were recommended for excision based on follow-up imaging with one malignancy diagnosed 2 years following biopsy. One additional patient had MRI-detected bilateral cancers remote from the biopsy site 3 years after biopsy. Overall cancer yield of lesions with follow-up MRI was 0.9 % (1/113); no cancers were detected at 6 months. Our data suggests that 6-month follow-up may not be required and that annual screening MRI would be acceptable to maintain a reasonable cancer detection rate. • Follow-up recommendations after benign concordant MRI-guided breast biopsy remain controversial. • Cancer detection rate was 0.9 % overall with no cancers detected at 6 months. • Short-interval follow-up after benign concordant MRI-guided breast biopsy may not be necessary.European Radiology 03/2014; DOI:10.1007/s00330-014-3125-x · 4.34 Impact Factor
Article: MRI vacuum-assisted breast biopsies[Show abstract] [Hide abstract]
ABSTRACT: The indications, technique, results and limitations of MRI vacuum-assisted breast biopsies are discussed from a review of the literature. This was initially a home-grown technique and its development was slowed down by several factors. As a result of major technical advances, it has become a reliable and very consistent procedure with a low rate of underestimation. It is now an undisputed technique when suspicious MRI enhancement is seen with no corresponding mammography or ultrasound features.09/2014; 95(9). DOI:10.1016/j.diii.2013.12.023