The Management of Benign Concordant MRI-guided Breast Biopsies: Lessons Learned

Abstract

After benign concordant magnetic resonance imaging (MRI)-guided breast biopsy, initial follow-up MRI at 6 months is often recommended for confirmation. This study was undertaken to determine the proper management of stable lesions on initial follow-up MRI and whether such follow-up can be safely deferred to 12 months. Retrospective review of 240 MRI-guided biopsies identified 156 benign concordant lesions. 85 eligible cases received follow-up MRI and constitute the study population. On initial follow-up MRI, 72 of 85 lesions appeared adequately sampled, 12 were stable and underwent further MRI follow-up, and 1 was benign on subsequent surgery. No cancers were diagnosed at the biopsy sites on either 6- or 12-month follow-up MRI. Among the 12 stable lesions, four were masses and eight were nonmass enhancements. One of the stable masses enlarged on 24-month follow-up MRI and proved malignant. All stable nonmass lesions were benign on long-term follow-up. After benign concordant MRI-guided breast biopsy, a stable mass has a 25% probability of malignancy in our series. Re-biopsy of such masses should be strongly considered. Stable nonmass lesions may be followed with subsequent MRI without rebiopsy. Deferral of initial follow-up MRI to 12 months may be acceptable.