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Fischer U. Breast MRI - The champion in the millimeter league: MIO breast MRI - The method of choice in women with dense breasts. Eur J Radiol 2023; 167:111053. [PMID: 37659208 DOI: 10.1016/j.ejrad.2023.111053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 08/16/2023] [Indexed: 09/04/2023]
Abstract
We perform MRI of the breast as a first pass technique. We successfully established 10-minute-protocols (including T2 images) with a fixed dosage of 5 ml 1 M CM. A high spatial resolution of 526 × 526, better 672 × 672 or maximum (1.024 × 1.024, MIO MRI) is vital to achieve best results. We use fixation tools to avoid motion artifacts. Motion correction algorithms can, however, often eliminate such artifacts when they are present. In initial breast MRI exams, morphologic features are the most important criteria for lesion evaluation. If previous exams are available for comparison, the main criteria indicating a suspicious lesion are an increase in lesion size or the depiction of new lesions. High quality HR MRI of the breast is the method of choice in women with dense or extremely dense breasts in all cases (screening, assessment, follow up). In density type A or B, MRI can be helpful in defined constellations, e.g. when MX and US are limited or contraindicated. According to our experience, 95% or more of all carcinomas of the breast are detectable on MRI. The remaining 5% of MRI-occult lesions are intraductal tumors or very small invasive carcinomas depicted with mammography due to associated microcalcifications. MRI is, however, superior to all other imaging modalities in the detection of the clinically relevant DCIS (high risk DCIS, intermediate type). Consecutive MRI examinations in intervals of 12 to 24 months allow a reliable detection of invasive breast cancer with an average size of 7-8 mm. This corresponds to a rate of metastasis-free locoregional lymph nodes in >95% of cases. The rate of interval cancers is <2%. In conclusion, this strategy may increase the overall-lifetime survival of breast cancer patients to more than 95%. Inversely, mortality may be reduced to <5%. Taking these improvements in early breast cancer detection and survival that can be achieved through the implementation of QA HR MRI of the breast into account, it should be discussed to modify oncologic guidelines for the treatment of breast cancer. MRI is the best diagnostic tool we have and according to our experience, a first pass, quality-assured high-resolution breast MRI protocol provides best diagnostic results at minimal procedural effort.
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Affiliation(s)
- Uwe Fischer
- Diagnostic Breast Care Center, Bahnhofsallee 1d, 37081 Goettingen, Germany.
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Wang LC, Rao S, Schacht D, Bhole S. Reducing False Negatives in Biopsy of Suspicious MRI Findings. JOURNAL OF BREAST IMAGING 2023; 5:597-610. [PMID: 38416912 DOI: 10.1093/jbi/wbad024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Indexed: 03/01/2024]
Abstract
Breast MRI is a highly sensitive imaging modality that often detects findings that are occult on mammography and US. Given the overlap in appearance of benign and malignant lesions, an accurate method of tissue sampling for MRI-detected findings is essential. Although MRI-directed US and correlation with mammography can be helpful for some lesions, a correlate is not always found. MRI-guided biopsy is a safe and effective method of tissue sampling for findings seen only on MRI. The unique limitations of this technique, however, contribute to false negatives, which can result in delays in diagnosis and adverse patient outcomes; this is of particular importance as most MRI examinations are performed in the high-risk or preoperative setting. Here, we review strategies to minimize false negatives in biopsy of suspicious MRI findings, including appropriate selection of biopsy modality, use of meticulous MRI-guided biopsy technique, management after target nonvisualization, assessment of adequate lesion sampling, and determination of radiology-pathology concordance. A proposed management algorithm for MRI-guided biopsy results will also be discussed.
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Affiliation(s)
- Lilian C Wang
- Northwestern Medicine, Department of Radiology, Chicago, IL, USA
| | - Sandra Rao
- Northwestern Medicine, Department of Radiology, Chicago, IL, USA
| | - David Schacht
- Northwestern Medicine, Department of Radiology, Chicago, IL, USA
| | - Sonya Bhole
- Northwestern Medicine, Department of Radiology, Chicago, IL, USA
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Ambinder EB, Myers KS, Mullen LA, Di Carlo P, Philip M, Fragomeni R, Nguyen D, Oluyemi E. Breast MRI biopsy cancellation due to lesion nonvisualization. Breast J 2020; 26:2021-2025. [PMID: 32924192 DOI: 10.1111/tbj.14044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 11/30/2022]
Abstract
It is a clinical dilemma when a finding reported as suspicious on a breast MRI is not visualized at the time of a scheduled MRI-guided breast biopsy. We retrospectively reviewed all canceled MRI-guided biopsies at our institution between 6/1/2009 and 9/20/2019 and found a cancellation rate of 6.9% (72/1051). In one case, a mastectomy was performed after the canceled biopsy revealing a focus of DCIS in the same quadrant as the original finding (malignancy rate 2.1%). Our results support the current practice of 6-month follow-up MRI recommendation after a canceled MRI-guided biopsy for lesion nonvisualization.
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Affiliation(s)
- Emily B Ambinder
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Kelly S Myers
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Lisa A Mullen
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Philip Di Carlo
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Mary Philip
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Roberto Fragomeni
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Derek Nguyen
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Eniola Oluyemi
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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Pinnamaneni N, Moy L, Gao Y, Melsaether AN, Babb JS, Toth HK, Heller SL. Canceled MRI-guided Breast Biopsies Due to Nonvisualization: Follow-up and Outcomes. Acad Radiol 2018; 25:1101-1110. [PMID: 29478921 DOI: 10.1016/j.acra.2018.01.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 12/02/2017] [Accepted: 01/13/2018] [Indexed: 10/17/2022]
Abstract
RATIONALE AND OBJECTIVE The objective of this study was to evaluate breast lesion outcomes in patients after canceled MRI-guided breast biopsy due to lesion nonvisualization. MATERIALS AND METHODS Electronic medical records (January 2007-December 2014) were searched for patients with canceled magnetic resonance imaging (MRI)-guided breast biopsies due to lesion nonvisualization. A total of 1403 MRI-detected lesions were scheduled for MRI-guided biopsy and 89 were canceled because of nonvisualization. Imaging studies and medical records were reviewed for patient demographics, lesion characteristics, and subsequent malignancy. Patients without adequate MRI follow-up imaging were excluded. Statistical analysis was employed to determine if patient demographics or lesion characteristics were predictive of lesion resolution or lesion biopsy after subsequent follow-up. RESULTS Eighty-nine (6.3% [89/1403]; 95% confidence interval, 5.2%-7.7%) biopsies in 89 women were canceled because of nonvisualization. Follow-up MRIs greater than 5.5 months were available for 60.7% (54/89) of women. In 74.1% (40/54) of these patients, the lesions completely resolved on follow-up. In 25.9% (14/54) of the patients, the lesion persisted on follow-up; 42.9% (6/14) of these patients underwent biopsy. One case (1.9% [1/54]) yielded ductal carcinoma in situ with microinvasion at the 6-month follow-up. No patient demographics or lesion features were associated with lesion resolution or lesion biopsy. CONCLUSIONS The majority of canceled MRI-guided biopsy lesions resolved on later follow-up; however, because of the small possibility of a missed malignancy, follow-up MRI imaging at 6 months is recommended.
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Ferré R, AlSharif S, Aldis A, Mesurolle B. The Positive Outcome of MRI-Guided Vacuum Assisted Core Needle Breast Biopsies Is Not Influenced by a Prior Negative Targeted Second-Look Ultrasound. Can Assoc Radiol J 2017; 68:401-408. [PMID: 28835335 DOI: 10.1016/j.carj.2017.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 02/04/2017] [Accepted: 03/28/2017] [Indexed: 10/19/2022] Open
Abstract
PURPOSE The study sought to investigate the outcome of breast magnetic resonance-guided biopsies as a function of the indication for magnetic resonance imaging (MRI), the MRI features of the lesions, and the performance or not of a targeted second-look ultrasound (SLUS) prior breast MRI-guided biopsy. METHODS We identified 158 women with MRI-detected breast lesions scheduled for MRI-guided biopsy (2007-2013). Patient demographics, performance of targeted SLUS, imaging characteristics, and subsequent pathology results were reviewed. RESULTS Three biopsies were deferred, and 155 lesions were biopsied under MRI guidance (155 women; median age 55.14 years; range 27-80 years). Ninety-eight women underwent a SLUS prior to the MRI-guided biopsy (63%). Of the 155 biopsied lesions, 23 (15%) were malignant, 106 (68%) were benign, and 26 (17%) were high risk. Four of 15 surgically excised high-risk lesions were upgraded to malignancy (27%). Most of the biopsied lesions corresponded to non-mass-like enhancement (81%, 126 of 155) and most of the biopsies (52%, 81 of 155) were performed in a screening context. No demographic or MRI features were associated with malignancy. No differences were noted between the 2 subgroups (prior SLUS vs no prior SLUS) except for the presence of a synchronous carcinoma associated with a likelihood of targeted SLUS before MRI-guided biopsy (P = .001). CONCLUSION A negative SLUS does not influence the pathology outcome of a suspicious lesion biopsied under MR guidance.
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Affiliation(s)
- Romuald Ferré
- Cedar Breast Clinic, McGill University Health Center, Royal Victoria Hospital, Montréal, Québec, Canada; Department of Radiology, North Ontario School of Medicine, Thunder Bay Regional Health Center, Thunder Bay, Ontario, Canada
| | - Shaza AlSharif
- Cedar Breast Clinic, McGill University Health Center, Royal Victoria Hospital, Montréal, Québec, Canada; Department of Medical Imaging, Ministry of National Guard Health Affairs, King Abdulaziz Bin Saud University for Health Sciences, Jeddah, Saudi Arabia
| | - Ann Aldis
- Cedar Breast Clinic, McGill University Health Center, Royal Victoria Hospital, Montréal, Québec, Canada
| | - Benoît Mesurolle
- Cedar Breast Clinic, McGill University Health Center, Royal Victoria Hospital, Montréal, Québec, Canada; Département d'imagerie médicale, Centre République, Clermont-Ferrand, France.
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Raza S, Chikarmane SA, Gombos EC, Georgian-Smith D, Frost EP. Optimizing Success and Avoiding Mishaps in the Most Difficult Image-guided Breast Biopsies. Semin Ultrasound CT MR 2017; 39:80-97. [PMID: 29317042 DOI: 10.1053/j.sult.2017.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Breast cancer is an increasing challenge in developed and limited resource areas of the world. Early detection of breast cancer offers the best chance for optimal care and best outcomes. A critical step in early detection is to obtain efficient and accurate tissue diagnoses. Although image-guided core needle breast biopsies are usually straightforward for experienced breast imagers, there are some not uncommon scenarios that present particular challenges. In this review article we will discuss these difficult situations and offer our tried and true methods to ensure safe and successful biopsies, while using stereotactic, ultrasound, and MRI guidance.
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Affiliation(s)
- Sughra Raza
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
| | - Sona A Chikarmane
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Eva C Gombos
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Dianne Georgian-Smith
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Elisabeth P Frost
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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7
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Chesebro AL, Chikarmane SA, Ritner JA, Birdwell RL, Giess CS. Troubleshooting to Overcome Technical Challenges in Image-guided Breast Biopsy. Radiographics 2017; 37:705-718. [DOI: 10.1148/rg.2017160117] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Allyson L. Chesebro
- From the Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass
| | - Sona A. Chikarmane
- From the Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass
| | - Julie A. Ritner
- From the Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass
| | - Robyn L. Birdwell
- From the Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass
| | - Catherine S. Giess
- From the Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass
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8
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Kılıç F, Eren A, Tunç N, Velidedeoğlu M, Bakan S, Aydoğan F, Çelik V, Gazioğlu E, Yılmaz MH. Magnetic Resonance Imaging Guided Vacuum Assisted and Core Needle Biopsies. THE JOURNAL OF BREAST HEALTH 2016; 12:25-30. [PMID: 28331727 DOI: 10.5152/tjbh.2015.2769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 10/26/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study to present the results of Magnetic resonance imaging (MRI) guided cutting needle biopsy procedures of suspicious breast lesions that can be solely detected on Magnetic resonance (MR) examination. MATERIALS AND METHODS The study included 48 patients with 48 lesions which were solely be observed in breast MRI, indistinguishable in ultrasonography and mammography, for MR guided vacuum-assisted cutting needle biopsy and 42 patients with 42 lesions for MR guided cutting needle biopsy for the lesions of the same nature. MR imaging was performed using a 1.5-Tesla MRI device. Acquired MR images were determined and biopsy protocol was performed using computer-aided diagnosis system on the workstation. Vacuum biopsies were performed using 10 G or 12 G automatic biopsy systems, cutting needle biopsy procedures were performed using fully automated 12 G biopsy needle. RESULTS All biopsy procedures were finalized successfully without major complications. The lesions were 54 mass (60%), 28 were non-mass contrast enhancement (31%) and 8 were foci (9%) in the MR examination. Histopathological evaluation revealed 18 malignant (invasive, in-situ ductal carcinoma and lobular carcinoma), 66 benign (apocrine metaplasia, fibrosis, fibroadenomatoid lesion, sclerosing adenosis, fibrocystic disease and mild-to-severe epithelial proliferation) and 6 high-risk (atypical ductal hyperplasia, intraductal papilloma, radial scar) lesions. CONCLUSION Magnetic resonance guided vacuum and cutting needle biopsy methods are successful methods fort he evaluation of solely MRI detected suspicious breast lesions. There are several advantages relative to each other in both methods.
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Affiliation(s)
- Fahrettin Kılıç
- Department of Radiology, İstanbul University Faculty of Medicine, İstanbul, Turkey
| | - Abdulkadir Eren
- Department of Radiology, İstanbul Medipol University, İstanbul, Turkey
| | - Necmettin Tunç
- Clinic of Radiology, Memorial Hospital, Diyarbakır, Turkey
| | - Mehmet Velidedeoğlu
- Department of General Surgery, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Selim Bakan
- Department of Radiology, İstanbul University Faculty of Medicine, İstanbul, Turkey
| | - Fatih Aydoğan
- Department of General Surgery, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Varol Çelik
- Department of General Surgery, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Ertuğrul Gazioğlu
- Department of General Surgery, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Mehmet Halit Yılmaz
- Department of Radiology, İstanbul University Faculty of Medicine, İstanbul, Turkey
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9
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Niell BL, Gavenonis SC, Motazedi T, Chubiz JC, Halpern EF, Rafferty EA, Lee JM. Auditing a breast MRI practice: performance measures for screening and diagnostic breast MRI. J Am Coll Radiol 2014; 11:883-9. [PMID: 24787571 PMCID: PMC4156888 DOI: 10.1016/j.jacr.2014.02.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 02/06/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Breast MRI is increasingly used for both screening and diagnostic purposes. Although performance benchmarks for screening and diagnostic mammography have been published, performance benchmarks for breast MRI have yet to be established. The purpose of this study was to comprehensively evaluate breast MRI performance measures, stratified by screening and diagnostic indications, from a single academic institution. METHODS Institutional review board approval was acquired for this HIPAA-compliant study. Informed consent was not required. Retrospective review of the institutional database identified all breast MRI examinations performed from April 1, 2007, to March 31, 2008. After application of exclusion criteria, the following performance measures for screening and diagnostic indications were calculated: cancer detection rate, positive predictive value (PPV), and abnormal interpretation rates. RESULTS The study included 2,444 examinations, 1,313 for screening and 1,131 for diagnostic indications. The cancer detection rates were 14 per 1,000 screening breast MRI examinations and 47 per 1,000 diagnostic examinations (P < .00001). The abnormal interpretation rate was 12% (152 of 1,313) for screening and 17% (194 of 1,131) for diagnostic indications (P = .00008). The PPVs of MRI were lower for screening [PPV1 (abnormal findings) = 12%, PPV2 (biopsy recommended) = 24%, PPV3 (biopsy performed) = 27%] compared with diagnostic indications (PPV1 (abnormal findings) = 28%, PPV2 (biopsy recommended) = 36%, PPV3 (biopsy performed) = 38%]. CONCLUSIONS Breast MRI performance measures differ significantly between screening and diagnostic MRI indications. Medical audits for breast MRI should calculate performance measures for screening and diagnostic breast MRI separately, as recommended for mammography.
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Affiliation(s)
- Bethany L. Niell
- Massachusetts General Hospital Avon Comprehensive Breast Evaluation Center Wang Building Suite 240 Boston, Massachusetts 02114 Telephone: 617-726-3093 Fax: 617-726-1074
| | - Sara C. Gavenonis
- Department of Radiology Christiana Care Health System 4755 Ogletown-Stanton Road Newark, Delaware 19718 Telephone: 302-623-4122 Fax: 302-623-4204
| | - Tina Motazedi
- University of Texas Health Science Center San Antonio School of Medicine 7703 Floyd Curl Drive San Antonio, TX 78229 Telephone: 713-303-1129
| | - Jessica Cott Chubiz
- Massachusetts General Hospital Department of Radiology Institute for Technology Assessment 101 Merrimac Street, 10th Floor Boston, Massachusetts 02114 Telephone: 617-726-0849 Fax: 617-726-9414
| | - Elkan F. Halpern
- Massachusetts General Hospital Department of Radiology Institute for Technology Assessment 101 Merrimac Street, 10th Floor Boston, Massachusetts 02114 Telephone: 617-726-0849 Fax: 617-726-9414
| | - Elizabeth A. Rafferty
- Massachusetts General Hospital Avon Comprehensive Breast Evaluation Center Wang Building Suite 240 Boston, Massachusetts 02114 Telephone: 617-726-3093 Fax: 617-726-1074
| | - Janie M. Lee
- Contact information at the time of the study: Massachusetts General Hospital Department of Radiology Institute for Technology Assessment 101 Merrimac Street, 10th Floor Boston, Massachusetts 02114 Telephone: 617-726-0849 Fax: 617-726-9414
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10
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Manion E, Brock JE, Raza S, Reisenbichler ES. MRI-guided breast needle core biopsies: pathologic features of newly diagnosed malignancies. Breast J 2014; 20:453-60. [PMID: 25040910 DOI: 10.1111/tbj.12300] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Magnetic resonance imaging (MRI) of the breast is used for select groups of patients. MRI-guided breast core needle biopsies performed over a 3-year period were retrospectively reviewed to determine the incidence and types of cancers found and to correlate the cancers with the MRI findings and the indication for the study. Patients were stratified based on indication for MRI examination including, evaluation of disease extent in patients with current ipsilateral carcinoma, surveillance for recurrence of prior ipsilateral carcinoma, as a problem-solving method and for screening high-risk patients. The high-risk screening group included those with family history (with or without germline mutations), prior chest wall radiation, and contralateral breast carcinoma (current or prior). Four-hundred and forty-five biopsies were performed on 386 patients. The majority of biopsies (79%) were benign. Biopsies demonstrating ductal carcinoma in situ (DCIS) and invasive carcinoma were more likely to present as nonmass-like and mass-forming enhancements respectively, but with only 52% specificity. The highest rate of malignancy (44%) was seen in the least frequently biopsied patient group (n = 25), those with prior ipsilateral carcinoma. Conversely, the most frequently biopsied group (n = 283), the high-risk screening group, demonstrated the lowest malignancy rate (16%). Within this group, most malignant cases were invasive carcinomas (n = 27), 67% of which were small (≤1 cm), well or moderately differentiated with a good prognostic receptor profile (estrogen receptor positive, human epidermal growth factor receptor 2 negative), and lacked nodal macrometastases. The remaining malignant cases in the high-risk screening group were DCIS with or without microinvasion (n = 18), 78% of which demonstrated high nuclear grade. Overall, enhancement pattern did not correlate with the likelihood of or type of malignancy. The most common types of carcinomas identified by screening were small estrogen receptor positive invasive tumors and high grade DCIS.
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Affiliation(s)
- Elizabeth Manion
- Department of Pathology, Saint Luke's Hospital System, Kansas City, Missouri
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11
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Bahrs S, Hattermann V, Preibsch H, Hahn M, Staebler A, Claussen C, Siegmann-Luz K. MR imaging-guided vacuum-assisted breast biopsy: Reduction of false-negative biopsies by short-term control MRI 24–48 h after biopsy. Clin Radiol 2014; 69:695-702. [DOI: 10.1016/j.crad.2014.02.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 02/16/2014] [Accepted: 02/19/2014] [Indexed: 11/25/2022]
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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.
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Affiliation(s)
- R Plantade
- Nice Europe Imaging Centre, 15, rue Alberti, 06000 Nice, France.
| | - I Thomassin-Naggara
- Department of Radiology, Tenon Hospital, Paris Public Hospitals Health Service (AP-HP), Pierre et Marie Curie University Oncology Institute, 4, rue de la Chine, 75020 Paris, France
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13
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Abstract
OBJECTIVE The reported frequency of aborted MRI-guided breast biopsies ranges from 8% to 17%, usually secondary to nonvisualization at attempted biopsy. Our study examines the frequency of MRI-guided breast biopsies aborted because of lesion nonvisualization and the subsequent risk of malignancy. MATERIALS AND METHODS We identified 350 patients and 445 lesions scheduled for MRI-guided biopsy between January 1, 2007, and December 31, 2009. Medical records and imaging studies were reviewed to ascertain patient demographics, lesion and imaging characteristics, and subsequent pathology results. Chi-square statistics were calculated for patient level analyses. RESULTS MRI-guided biopsies were aborted in 13% (56/445) of lesions and 15% (53/350; 95% CI, 11.6-19.3%) of patients because of nonvisualization of the biopsy target at the time of attempted biopsy. Of these 53 patients, 50 patients had follow-up data available. Malignancy was subsequently diagnosed in five of those 50 patients (10%; 95% CI, 3.3-21.8%), three with invasive ductal carcinomas and two with ductal carcinoma in situ. The mean time to malignant diagnosis from the date of aborted biopsy was 2.6 months (range, 1.1-6.9 months). CONCLUSION Informed consent for MRI-guided breast biopsies should include discussion of biopsy cancellation because of nonvisualization of the target lesion. The low yet significant risk of malignancy in patients subsequent to an aborted MRI-guided breast biopsy warrants short-term follow-up MRI after a canceled biopsy.
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JOURNAL CLUB: Is Screening MRI Indicated for Women With a Personal History of Breast Cancer? Analysis Based on Biopsy Results. AJR Am J Roentgenol 2013; 201:919-27. [DOI: 10.2214/ajr.11.8450] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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15
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Belloni E, Panizza P, Ravelli S, De Cobelli F, Gusmini S, Losio C, Sassi I, Perseghin G, Del Maschio A. MR-guided stereotactic breast biopsy using a mixed ferromagnetic-nonmagnetic coaxial system with 12- to 18-gauge needles: clinical experience and long-term outcome. LA RADIOLOGIA MEDICA 2013; 118:1137-48. [PMID: 23801401 DOI: 10.1007/s11547-013-0954-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 04/10/2012] [Indexed: 10/26/2022]
Abstract
PURPOSE This study investigated the clinical application of a magnetic-resonance (MR)-guided breast biopsy (MRBB) system consisting of a nonmagnetic coaxial needle and a ferromagnetic core biopsy needle. MATERIALS AND METHODS MRBB was performed on 70 breast lesions. The biopsy device consisted of a nonmagnetic 14- to 16-gauge coaxial needle and a ferromagnetic 16- to 18-gauge biopsy needle. RESULTS Of the 70 lesions, 29 were malignant and 41 nonmalignant. All 29 malignant lesions underwent surgery and were confirmed as malignant at final histology. Of the 41 nonmalignant lesions, 35 underwent follow-up breast MR imaging (mean, 26 ± 19 months), which demonstrated no lesions changes; six lesions underwent surgery because of poor radiological-pathological correlation; of these 6 lesions, 3 were nonmalignant, one was borderline (lobular carcinoma in situ) and two were malignant (well-differentiated tubular carcinoma and infiltrating ductal carcinoma). Sensitivity, specificity, positive and negative predictive values and diagnostic accuracy were, respectively, 93.5%, 100%, 100%, 95.1% and 97.1% if the lobular carcinoma in situ was considered a nonmalignant histological result, and 90.6%, 100%, 100%, 92.7% and 95.7% if the lobular carcinoma in situ was considered malignant. CONCLUSIONS MRBB with a ferromagnetic-nonmagnetic coaxial system represented an easy way to perform a biopsy procedure and was easily applicable in the routine clinical setting.
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Affiliation(s)
- Elena Belloni
- Radiology Department, Guglielmo da Saliceto Hospital, Cantone del Cristo, 29100, Piacenza, Italy,
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16
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Intussusception in adults: what radiologists should know. Emerg Radiol 2011; 19:89-101. [PMID: 22200965 DOI: 10.1007/s10140-011-1006-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2011] [Accepted: 11/22/2011] [Indexed: 12/14/2022]
Abstract
Adult intussusception (AI) is a rare entity with an organic lesion within the intussusception in 70-90% of the cases. Intussusception is classified according to location, etiology, and to the presence or not of a lead point. We illustrate several causes of AI with a variety of radiological findings on plain film, ultrasonography, computed tomography, magnetic resonance, and endoscopy seen at our institution. Imaging plays a major role in their diagnosis and in determining the appropriate treatment.
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Yilmaz MH, Kilic F, Icten GE, Aydogan F, Ozben V, Halac M, Olgun DC, Gazioglu E, Celik V, Uras C, Altug ZA. Radio-guided occult lesion localisation for breast lesions under computer-aided MRI guidance: the first experience and initial results. Br J Radiol 2011; 85:395-402. [PMID: 22010030 DOI: 10.1259/bjr/30798119] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The purpose of this study was to present an alternative technique for the pre-operative localisation of solely MRI-detected suspicious breast lesions using a computer-assisted MRI-guided radio-guided occult lesion localisation (ROLL) technique. METHODS Between January 2009 and June 2010, 25 females with a total of 25 suspicious breast lesions that could be detected only by MRI, and for whom breast surgery was planned, underwent the computer-assisted MRI-guided ROLL technique. A seven-channel biopsy breast array coil and computerised diagnostic workstation were used for the localisation procedure. Three-phase dynamic contrast-enhanced axial images were taken. After investigating the localisation co-ordinates with the help of intervention software on a workstation, an 18 G coaxial cannula was placed in the exact position determined. Following verification of the cannula position by additional axial scans, (99m)Tc-labelled macroalbumin aggregate and MRI contrast material were injected. Post-procedure MRI scans were used to confirm the correct localisation. RESULTS All the procedures were technically successful. The mean lesion size was 10.8 mm (range: 4-25 mm). The mean total magnet and the mean localisation times were 28.6 min (range: 18-46 min) and 13.1 min (range: 8-20 min), respectively. Grid and pillar methods were used for localisation in 24 procedures and 1 procedure, respectively. On histopathological examination, 6 malignant, 10 high-risk and 9 benign lesions were identified. All patients tolerated the procedure well. There were no major complications. CONCLUSION This is the first report documenting the application of MRI-guided ROLL. Based on our preliminary results, this technique is very efficient and seems to be a good alternative to wire localisation.
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Affiliation(s)
- M H Yilmaz
- Department of Radiology, Istanbul University, Cerrahpasa Medical School, Istanbul, Turkey
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Wertigkeit der Mamma-MRT als Ergänzung zu Mammographie und Sonographie bei Patientinnen mit erhöhtem Mammakarzinomrisiko. Radiologe 2008; 48:351-7. [DOI: 10.1007/s00117-008-1638-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Carlson JW, Birdwell RL, Gombos EC, Golshan M, Smith DN, Lester SC. MRI-directed, wire-localized breast excisions: incidence of malignancy and recommendations for pathologic evaluation. Hum Pathol 2007; 38:1754-9. [PMID: 17868777 DOI: 10.1016/j.humpath.2007.04.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2007] [Revised: 04/24/2007] [Accepted: 04/25/2007] [Indexed: 11/20/2022]
Abstract
Magnetic resonance imaging (MRI) has an evolving role in the evaluation of breast lesions and is currently being used for the screening of high-risk patients (eg, women with a personal or family history of breast cancer), for the evaluation of extent of disease in patients with a current diagnosis of cancer, and for patients with suspicious, but indeterminate, findings by other imaging modalities. If a suspicious lesion detected by MRI is not well visualized by another method, an MRI-directed core biopsy or breast excision may be performed. MRI cannot be used to verify the lesion in the specimen because MRI lesion detection is dependent on uptake of gadolinium after intravenous injection. Accordingly, these breast excisions present unique challenges to pathologists. The purpose of this report is to define the surgical pathology issues involved in processing MRI-localized excisions. Retrospective review of 85 consecutive MRI-directed breast excisions from 77 patients was performed. Malignant lesions were present in 20 (24%) of 85 excisions, including 10 cases of invasive carcinoma (median size, 0.4 cm), 9 cases of ductal carcinoma in situ, and 1 case of lymphoma. Most of the malignancies (85% or 17/20) had no associated gross finding and only 5 (25%) of 20 of these malignancies were associated with a definite finding on the specimen radiograph. This study demonstrates that gross examination and specimen radiography do not identify most of the malignancies in MRI-localized biopsies and, therefore, optimal processing requires complete microscopic examination of these specimens.
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Affiliation(s)
- Joseph W Carlson
- Department of Pathology, Brigham and Women's Hospital, Boston, MA 02115, USA.
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Warren R, Eleti A. Overdiagnosis and overtreatment of breast cancer: is overdiagnosis an issue for radiologists? Breast Cancer Res 2006; 8:205. [PMID: 16677422 PMCID: PMC1557715 DOI: 10.1186/bcr1396] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Overdiagnosis is diagnosis of cancers that would not present within the life of the patient and is one of the downsides of screening. This applies to low-grade ductal carcinoma in situ and some small grade 1 invasive cancers. Radiologists are responsible for cancer diagnosis, but at the time of diagnosis they cannot determine whether a particular low-grade diagnosis is one to which the definition of overdiagnosis applies. Overdiagnosis is likely to be driven by technological developments, including digital mammography, computer-aided detection and improved biopsy techniques. It is also driven by the patient's fear that cancer will be missed and the doctor's fear of litigation. It is therefore an issue of importance for radiologists, presenting them with difficult fine-tuned decisions in every assessment clinic that are ultimately counted later by those who evaluate their screening.
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Affiliation(s)
- Ruth Warren
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Asha Eleti
- Department of Radiology, University of Cambridge, Cambridge, UK
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