MRI-guided Core Needle Biopsy Research Articles

CLINICAL VALUE OF MAGNETIC RESONANCE IMAGING-GUIDED CORE NEEDLE AND VACUUM-ASSISTED BREAST BIOPSIES

Breast cancer is the most common oncological disease in women. When changes in the breasts are not visible on an ultrasound or mammogram, they can be detected by a magnetic resonance imaging (MRI) scan. A biopsy of the breast tissue is performed to examine the changes and predict the most suitable further treatment method. Most often, a core needle biopsy is performed under ultrasound or mammography guidance, but if lesions are only visible on MRI images, the biopsy should be performed under MRI control. MRI-guided biopsy is a relatively new diagnostic method. The aim of our study was to assess the clinical value of MRI-guided core nee­dle and vacuum-assisted core needle breast biopsies. We conducted a systematic literature analysis. Articles were retrieved from PubMed and ClinicalKey electronic data­bases. Eligible articles were selected based on inclusion and exclusion criteria. 12 articles were included from 512 publications. We conclude that MRI -guided core needle and vacuum-assissted core needle biopsies are a safe and effective method of taking a breast tissue biopsy, allowing you to assess abnormalities that are not visible on mammography or ultrasound. MRI-guided biopsy is appropriate for all patients with suspicious lesions seen only on MRI, irrespective of breast cancer risk, as ma­lignant lesions are likely to be found in ~21% of patients. MRI-guided core needle biopsies have a low compli­cation rate. The diagnostic performance of MRI-guided core needle biopsy (sensitivity ~ 93%) is comparable to the diagnostic performance of other image-guided breast biopsy techniques.

A Technique to Manage the Inaccessible Lesion at MRI-guided Core-needle Biopsy

A Technique to Manage the Inaccessible Lesion at MRI-guided Core-needle Biopsy

PD11-11 A URINARY EXOSOME ASSAY INTERROGATING SMALL NON-CODING RNAS ACCURATELY IDENTIFIES AND STRATIFIES PROSTATE CANCER INTO LOW- INTERMEDIATE- OR HIGH-RISK DISEASE

You have accessJournal of UrologyCME1 May 2022PD11-11 A URINARY EXOSOME ASSAY INTERROGATING SMALL NON-CODING RNAS ACCURATELY IDENTIFIES AND STRATIFIES PROSTATE CANCER INTO LOW- INTERMEDIATE- OR HIGH-RISK DISEASE Laurence Klotz, Winnie Wang, Alvin Lopez Pujals, Deepak Kapoor, Rebecca DeVaux, Greg DiRienzo, Federico Corica, Ann Anderson, Carl Olsson, Alberto Corica, James Libby, and Martin Tenniswood Laurence KlotzLaurence Klotz More articles by this author , Winnie WangWinnie Wang More articles by this author , Alvin Lopez PujalsAlvin Lopez Pujals More articles by this author , Deepak KapoorDeepak Kapoor More articles by this author , Rebecca DeVauxRebecca DeVaux More articles by this author , Greg DiRienzoGreg DiRienzo More articles by this author , Federico CoricaFederico Corica More articles by this author , Ann AndersonAnn Anderson More articles by this author , Carl OlssonCarl Olsson More articles by this author , Alberto CoricaAlberto Corica More articles by this author , James LibbyJames Libby More articles by this author , and Martin TenniswoodMartin Tenniswood More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002537.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The miR Sentinel® Test measures the expression of 442 small non-coding RNAs (sncRNAs) extracted from urinary exosomes to differentiate patients with No Molecular Evidence of Prostate Cancer (NMEPCa) from those with Molecular Evidence of Prostate Cancer (MEPCa). The test further classifies men with MEPCa into low-, intermediate- or high-risk disease. We compared the results of the miR Sentinel® PCC4 Test to systematic and MRI-guided core needle biopsy in men at risk for prostate cancer. METHODS: 763 biopsy naïve men in whom a prostate biopsy was indicated, were recruited. sncRNAs were isolated from urinary exosomes and interrogated by RT-qPCR on a custom designed OpenArray platform. RESULTS: The validation cohort consisted of 763 biopsy naïve patients undergoing systematic or systematic plus targeted biopsy. The molecular classification was compared to the Gleason Grade Group (GG) (Table 1). Sensitivity for the classification of {NPEPC or GG1} versus {GG2-5} was 75+18+4+105=203)/221=92.2% and the negative predictive value for absence of CS PCa was (221+64+12+123=420)/(238+200=420)= 96%. The apparent false positive rate for CS cancer was (34+35+32+22=(123)/(543) = 23%. 208 of the patients had discordant systematic and targeted biopsies. 29 of these had a negative systematic biopsy and a positive targeted biopsy. The molecular test predicted the targeted biopsy outcome in 27/29=93.1% overall, and in 14/15 (93%) of the cases with clinically significant cancer. In the 18 patients with positive systematic and negative MRI targeted biopsies, the test result predicted the positive biopsy in 100%. CONCLUSIONS: The miR Sentinel Test offers an accurate non-invasive means to accurately identify the presence or absence of prostate cancer and classify risk status predict pathological grade on biopsy. The high predictive accuracy of the test in patients whose systematic and targeted biopsy were discordant suggests that the 23% discordance between negative biopsy results and positive Sentinel Test results was in most cases due to false negative biopsies. Source of Funding: The study was funded by miR Scientific © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e194 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Laurence Klotz More articles by this author Winnie Wang More articles by this author Alvin Lopez Pujals More articles by this author Deepak Kapoor More articles by this author Rebecca DeVaux More articles by this author Greg DiRienzo More articles by this author Federico Corica More articles by this author Ann Anderson More articles by this author Carl Olsson More articles by this author Alberto Corica More articles by this author James Libby More articles by this author Martin Tenniswood More articles by this author Expand All Advertisement PDF DownloadLoading ...

MRI-guided core needle biopsy of the breast: Radiology-pathology correlation and impact on clinical management

ObjectiveBreast MRI is used to screen high-risk patients and determine extent of disease in breast cancer (BC) patients. The goal of this study was to determine the pathologic correlates of breast MRI abnormalities biopsied under MRI guidance. MethodsWe retrospectively identified 101 MRI-guided core needle biopsies (CNB) of the breast from 79 women over a 4-year period. MRI-detected lesions biopsied with ultrasound or stereotactic guidance were excluded. MRI studies and pathology were reviewed by breast radiologists and pathologists. ResultsOf the 79 patients, 72 (91%) had a history of prior (n = 13) or concurrent (n = 59) BC. There were 101 MRI abnormalities: 60 (59%) with non-mass enhancement (NME) and 41 (41%) with mass enhancement. Pathology was benign in 83/101 (82%), including in the majority of NME lesions (43/60, 72%). The most common benign findings were: fibrocystic changes (FCC) (49%), sclerosing lesions (13%), and fibroadenoma (FA) (9%). There were 18 (18%) malignant diagnoses: 8 (44%) invasive lobular carcinoma (ILC), 7 (39%) ductal carcinoma in situ (DCIS), and 3 (17%) invasive ductal carcinoma (IDC). Of the 18 malignant diagnoses, 16 (89%) occurred in 14 unique patients with concurrent BC. Based on the malignant MRI-guided CNB, 6 (46%) of these patients had additional (sentinel lymph node biopsy or contralateral breast surgery) or more extensive (wider lumpectomy) surgery. ConclusionIn this series, most MRI-guided CNB of the breast were benign. The vast majority of malignant diagnoses occurred in patients with concurrent BC and frequently resulted in changes in clinical management.

MRI-Guided Percutaneous Biopsy of Mediastinal Masses Using a Large Bore Magnet: Technical Feasibility.

To evaluate the diagnostic accuracy and safety of magnetic resonance imaging (MRI)-guided percutaneous biopsy of mediastinal masses performed using a wide-bore high-field scanner. This is a retrospective study of 16 consecutive patients (8 male, 8 female; mean age 74 years) who underwent MRI-guided core needle biopsy of a mediastinal mass between February 2010 and January 2014. Size and location of lesion, approach taken, time for needle placement, overall duration of procedure, and post-procedural complications were evaluated. Technical success rates and correlation with surgical pathology (where available) were assessed. Target lesions were located in the anterior (n = 13), middle (n = 2), and posterior mediastinum (n = 1), respectively. Mean size was 7.2 cm (range 3.6-11 cm). Average time for needle placement was 9.4 min (range 3-18 min); average duration of entire procedure was 42 min (range 27-62 min). 2-5 core samples were obtained from each lesion (mean 2.6). Technical success rate was 100%, with specimens successfully obtained in all 16 patients. There were no immediate complications. Histopathology revealed malignancy in 12 cases (4 of which were surgically confirmed), benign lesions in 3 cases (1 of which was false negative following surgical resection), and one inconclusive specimen (treated as inaccurate since repeat CT-guided biopsy demonstrated thymic hyperplasia). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy in our study were 92.3, 100, 100, 66.7, and 87.5%, respectively. MRI-guided mediastinal biopsy is a safe procedure with high diagnostic accuracy, which may offer a non-ionizing alternative to CT guidance.

Features of non-mass enhancing lesions detected on 1.5 T breast MRI: a radiologic and pathologic analysis.

With increased utilization of magnetic resonance imaging (MRI) of the breast in clinical practice, many non-mass lesions are being detected incidentally. Although MRI-guided biopsies are usually performed for these lesions, no clear guidelines exist to determine the management of these lesions. The purpose of this study was to explore the pathological features of incidentally detected non-mass lesions on breast MRI to determine rates of malignancy and to assess the predictive value of kinetic enhancement curves for further characterization of these lesions as benign versus malignant. A retrospective review was performed of all MRI-guided core needle biopsies done at our institution between January 2009 and January 2012. 172 consecutively biopsied lesions were identified. 43% of the lesions were non-mass lesions, out of which 74.3% were benign, whereas 14.9% and 10.8% of these lesions had malignant and atypical features, respectively. The most commonly encountered non-mass malignant lesion was ductal carcinoma in situ, whereas the most frequently seen invasive non-mass lesion was invasive lobular carcinoma. Kinetic enhancement curves for these lesions did not demonstrate a statistically significant relationship with their pathologic features. Non-mass enhancing lesions incidentally detected on breast MRI carry a significant risk of atypia and malignancy, either in situ or invasive. Hence, it is prudent to biopsy these lesions.

Why Are Patients Noncompliant With Follow-Up Recommendations After MRI-Guided Core Needle Biopsy of Suspicious Breast Lesions?

The objective of this study was to investigate patient and breast MRI characteristics associated with noncompliance with recommended follow-up after MRI-guided core needle biopsy of suspicious breast lesions. A retrospective review was performed of 576 breast lesions biopsied under MRI guidance between 2007 and 2010. Patient follow-up was obtained from the medical record and from contact with referring physicians. Of 415 women who underwent 576 MRI-guided core needle biopsies for suspicious breast lesions, 123 (29.6%) patients representing 154 of 576 (26.7%) lesions were noncompliant with recommended excision or 6-month MRI follow-up. Referring physicians provided information for 63% (97/154) of lesions in noncompliant patients, of which 49.5% (48/97) were followed by mammography instead of excision or MRI. Noncompliance with MRI follow-up was significantly associated with referral for biopsy by outside hospital physicians (odds ratio [OR], 2.40; p = 0.0001) and with referral for screening MRI (1.46; p = 0.093) and biopsy of a focus or foci lesion (1.63; p = 0.088). Among 178 lesions in patients compliant with follow-up MRI after MRI-guided core needle biopsy, 7.9% (14/178) had abnormal follow-up MRI results, half of which (3.9%, 7/178) were found on repeat biopsy to be high-risk or malignant. Institutions performing MRI-guided core biopsies should be aware that patients referred from outside institutions are more likely to be noncompliant with recommended follow-up. Strategies to improve follow-up should include educating patients on the difference between mammography and MRI follow-up.

Abstract P4-01-12: Compliance with Recommended Follow-Up after MRI-guided Core Needle Biopsy of Suspicious Breast Lesions: A Retrospective Study

Abstract Purpose: The purpose of this study was to assess patient compliance with recommended follow-up after MRI-guided core needle biopsy and investigate the reasons why patients did not comply with their recommended MRI imaging follow-up. Materials and Methods: A HIPAA compliant retrospective review was performed of 576 MRI-guided core needle biopsies between 2007–2010 with IRB approval and waiver of informed consent. Of 576 biopsies, 73.3% (422/576) were compliant and 26.7% (154/576) were noncompliant with follow-up recommendations and composed this study. Imaging and surgical planning was determined by comparing imaging findings, clinical findings, and biopsy histology. Results: Out of 135 lesions in patients noncompliant with follow-up imaging, 50.4% (68/135) were referred for biopsy by non-affiliated physicians, 41.5% (56/135) received a screening MRI, and 40.3% (56/135) were a focus or foci. Referring physicians provided information regarding the follow-up status of 88/154 (57%) lesions in noncompliant patients, of which 44/88 (50%) were followed by mammogram instead of MRI. Among compliant patients, 7/178 (3.9%) lesions seen on follow-up MRI were found to be high risk or malignant. Conclusion: Compliance with follow-up MRI recommendation after core needle biopsy is low. Three characteristics were found to be associated with noncompliance with follow-up imaging: referral from non-affiliated physician, screening MRI, and a focus lesion. Moreover, patients who do not comply with recommended MRI follow-up are more likely to have follow-up mammography. Follow-up imaging among compliant patients found high-risk lesions and malignancy. Facilities performing MRI-guided core biopsies should therefore be aware of a high risk of noncompliance with follow-up. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-01-12.

Magnetic Resonance Imaging-Guided Breast Biopsy in Lesions Not Visualized by Mammogram or Ultrasound

The use of magnetic resonance imaging (MRI) for the diagnosis and evaluation of breast lesions is still in evolution. The aim of this study was to evaluate the outcome of MR-guided biopsy for suspicious lesions seen on MRI but not visualized by mammography or ultrasound. A retrospective review was conducted on all patients undergoing MRI-guided core needle biopsy at a National Cancer Institute-designated comprehensive cancer center. Biopsies were performed using a 1.5-Tesla MR with a seven-channel breast coil taking six cores in a clock face configuration with a 10-gauge vacuum-assisted VACORA biopsy device. One hundred twenty-seven patients underwent 187 biopsies without major complication. The lesion size ranged from 4 to 12 mm. Pathology on MRI-guided core biopsy material revealed 126 (68%) benign lesions. Of these, 12 were intraductal papillomas and two were fibroadenomas. Sixty-one (32%) were deemed clinically significant and included the following pathology: invasive cancer 19 patients (10%), ductal carcinoma in situ (DCIS) in 25 patients (13%), atypical ductal hyperplasia (ADH) 15 patients (8%), and lobular carcinoma in situ in one patient (1%). There were two specimens upgraded from ADH to DCIS and one specimen that was biopsied was called ADH but there was no residual atypia on final pathology. With a median follow-up of 24 months, there were no patients with benign pathology returning with a clinically significant lesion later. MRI-guided biopsy provides an accurate and safe method for sampling suspicious lesions when no other reasonable means of biopsy is available. MRI-guided biopsy yielded clinically significant findings in approximately one-third of the sampled specimens. This technique can provide a good representative sample of clinically significant pathology. MRI-guided biopsy is a relatively new modality, which can provide a nonsurgical diagnostic specimen in the absence of mammographic or ultrasound findings.

Factors That Impact the Duration of MRI-Guided Core Needle Biopsy

The purpose of our study was to determine which patient-related, target lesion-related, or procedure-related variables impact the duration of MRI-guided core needle breast biopsy. Between July 11, 2006, and September 26, 2007, data were collected for 75 single-target MRI-guided 9-gauge vacuum-assisted core needle biopsy procedures using a grid-guidance technique and performed at a single institution. The following variables were studied: MRI suite occupation time, number of operators, patient age and breast size, target morphology and location, approach to target, equipment used, number of image acquisitions and times the patient was moved in and out of the closed magnet, and occurrence of complications. Statistical analysis was performed using the Student's t test, analysis of variance, and Pearson's correlation, with p values < 0.05 considered significant. The mean duration was 57.9 minutes (SD, 17.2 minutes; range, 30-109 minutes). None of the patient- or target-related variables significantly impacted the duration, although lesions located in the anterior third of the breast showed a trend to prolong the procedure (p = 0.059). The time to complete a procedure was reduced when the operating radiologist was assisted by a breast imaging fellow-in-training (p = 0.01). Increasing numbers of image acquisitions and times the patient was moved in and out of the magnet significantly lengthened the procedure duration (p = 0.0001 for both). No major complications occurred. Biopsies yielded 16% (12/75) malignant and 84% (63/75) benign diagnoses. Variables that minimized procedure duration were number of image acquisitions, number of patient insertions or removals from the magnet, and assistance of a breast imaging fellow-in-training. No patient-related or target-related variables impacted procedure time.

Adequate histologic sampling of breast magnetic resonance imaging-guided core needle biopsy.

Abstract Context.—The increasing use of contrast-enhanced magnetic resonance imaging (MRI) of the breast as a valuable adjunct to mammography and ultrasound in the detection of breast lesions, in association with needle core biopsy taken from the suspicious areas, has major workload implications for histopathology laboratories wherever breast MRI is practiced. Objective.—To establish the number of histologic levels necessary for the evaluation of breast MRI-guided needle core biopsy specimens taken from suspicious areas on breast MRI examination. Design.—Retrospective histologic review of a series of breast MRI-guided core needle biopsies, initially examined routinely at 4 levels, in the Pathology Department at Mount Sinai School of Medicine in New York, New York. Results.—Accurate diagnostic classification was possible after examination of the first level in 95.4% of cases. For a small group of patients (4.4%), 4 levels were considered to provide additional useful information, although this information d...

Adequate Histologic Sampling of Breast Magnetic Resonance Imaging–Guided Core Needle Biopsy

-The increasing use of contrast-enhanced magnetic resonance imaging (MRI) of the breast as a valuable adjunct to mammography and ultrasound in the detection of breast lesions, in association with needle core biopsy taken from the suspicious areas, has major workload implications for histopathology laboratories wherever breast MRI is practiced. -To establish the number of histologic levels necessary for the evaluation of breast MRI-guided needle core biopsy specimens taken from suspicious areas on breast MRI examination. -Retrospective histologic review of a series of breast MRI-guided core needle biopsies, initially examined routinely at 4 levels, in the Pathology Department at Mount Sinai School of Medicine in New York, New York. -Accurate diagnostic classification was possible after examination of the first level in 95.4% of cases. For a small group of patients (4.4%), 4 levels were considered to provide additional useful information, although this information did not alter the diagnosis. In only a single case (0.2%) was it likely that routine examination of 4 levels could have led to an incidental finding of a very small intraductal papilloma (0.15 cm) present only at the second histologic level. However, this incidental finding would have not changed the patient outcome. -Needle core biopsies for MRI-detected abnormalities should be routinely examined at only 1 level. Further levels may be needed in occasional cases to identify more conclusively an associated pathologic abnormality and may be of particular value when assessing atypical intraductal proliferative epithelial lesions.