MRI-guided Vacuum-assisted Breast Biopsy Research Articles

Usefulness of magnetic resonance imaging-guided vacuum-assisted breast biopsy in Korean women: a pilot study

BackgroundMagnetic resonance imaging (MRI)-guided vacuum-assisted biopsy is the technique of choice for lesions that are visible only with breast MRI. The purpose of this study was to report our clinical experience with MRI-guided vacuum-assisted biopsy in Korean women.MethodsA total of 13 patients with 15 lesions for MRI-guided vacuum-assisted biopsy were prospectively entered into this study between September 2009 and November 2011. Biopsy samples were obtained in a 3-T magnet using a 9-guage MRI-compatible vacuum-assisted biopsy device. We evaluated clinical indications for biopsy, lesion characteristics on prebiopsy MRI, pathologic results, and postbiopsy complication status.ResultsThe clinical indications for MRI-guided vacuum-assisted biopsy were as follows: abnormalities in patients with interstitial mammoplasty on screening MRI (n = 10); preoperative evaluation of patients with a recently diagnosed cancer (n = 3); and suspicious recurrence on follow-up MRI after cancer surgery (n = 1) or chemotherapy (n = 1). All lesions have morphologic features suspicious or highly suggestive of malignancy by the American College of Radiology Breast Imaging Reporting and Data System category of MRI (C4a = 12, C4b = 2, C5 = 1). In two of the 15 lesions (13.3%, <6 mm), MRI-guided 9-gauge vacuum-assisted breast biopsy was deferred due to nonvisualization of the MRI findings that led to biopsy and the lesions were stable or disappeared on follow up so were considered benign. Of 13 biopsied lesions, pathology revealed four malignancies (4/13, 30.8%; mean size 15.5 mm) and nine benign lesions (9/13, 69.2%; size 14.2 mm). Immediate postprocedural hematoma (mean size 23.5 mm) was observed in eight out of 13 patients (61.5%) and was controlled conservatively.ConclusionsOur initial experience of MRI-guided vacuum-assisted biopsy showed a success rate of 86.7% and a cancer diagnosis rate of 30.8%, which was quite satisfactory. MRI-guided vacuum-assisted breast biopsy is a safe and effective tool for the workup of suspicious lesions seen on breast MRI alone without major complication. This biopsy may contribute to the early diagnosis of breast cancer in interstitial mammoplasty patients in Korea.

Management of Breast Lesions Detectable Only on MRI

Breast MR imaging has become established as the most sensitive imaging method for diagnosing breast cancer. As a result of the increasing examination volume and improved image quality, the number of breast lesions detected only on MRI and requiring further clarification has risen in recent years. According to the S3-guideline "Diagnosis, Therapy, and Follow-Up of Breast Cancer" as revised in July 2012, institutions performing breast MRI should provide the option of an MRI-guided intervention for clarification. This review describes the indications, methods and results of MRI-guided interventions for the clarification of breast lesions only visible on MRI. Recent guidelines and study results are also addressed and alternative methods and pitfalls are presented. ▶ Up to 57 % of lesions originally visible only on MRI can be sonographically correlated and biopsied. ▶ MRI-guided intervention is necessary for the clarification of BI-RADS® 4 and 5 lesions detectable only on MRI ▶ MRI-guided vacuum-assisted breast biopsy should be preferentially used ▶ MRI-guided localization and surgical excision should be used if MRI-guided vacuum-assisted biopsy is not possible ▶ If BI-RADS® 4 and 5 findings visible only on MRI are not detectable on interventional MRI, a follow-up MRI should be performed within six months.

MRIガイド下乳房生検の初期経験

Almost all mammary lesions are detected by a mammography and an ultrasound. However, a small part of lesions cannot be shown by only a magnetic resonance imaging (MRI). MRI-guided vacuum-assisted breast biopsy is a very useful means for the pathological diagnosis of these lesions. We performed MRI-guided vacuum-assisted breast biopsy to 4 patients with the lesions seen only by MRI. Biopsies were safely and easily performed using biopsy software (syngo BreVis). These biopsied specimens resulted cancer in 1, adenoma in 1 and benign lesions in 2. With an increase of the opportunity of MRI for the mammary lesions, we expect these lesions become increasingly large. We believe that MRI-guided vacuum-assisted breast biopsy will be an important diagnostic modality.

MRI-Guided Vacuum-Assisted Breast Biopsy Performed at 3 T With a 9-Gauge Needle: Preliminary Experience

The purpose of this study was to test the feasibility of 3-T vacuum-assisted large-bore core biopsy of lesions detected with MRI of the breast. Our preliminary experience revealed that 3-T MRI-guided vacuum-assisted biopsy is a safe and effective interventional method that enables accurate biopsy of lesions identified with a 3-T MRI system. Artifacts on 3-T images did not result in failed biopsy; therefore, 3-T MRI systems can be used reliably for both diagnostic and interventional breast studies.

Papilloma Diagnosed at MRI-Guided Vacuum-Assisted Breast Biopsy: Is Surgical Excision Still Warranted?

The objective of our study was to determine the frequency of cancer at surgery in breast lesions yielding papilloma at MRI-guided 9-gauge vacuum-assisted biopsy (VAB) and to determine whether any features are associated with cancer upgrade. For this study, 1487 MRI-guided vacuum-assisted biopsies performed from January 2004 to March 2011 were reviewed. Lesions yielding papilloma were identified and classified as papilloma with or without atypia. Surgical findings were reviewed to determine the cancer rate. Statistical analysis was performed and 95% CIs were calculated. Papilloma was identified in 75 of the 1487 MRI-guided vacuum-assisted biopsies (5%). These 75 papillomas occurred in 73 women with a median age of 49 years (age range, 27-70 years). Of the 75 papillomas, 25 (33%) had atypia and 50 (67%) did not on core needle biopsy. Subsequent surgery of 67 of the 75 papillomas (89%) yielded ductal carcinoma in situ (DCIS) in four (6%; 95% CI, 2-15%). Surgery yielded DCIS in two of 23 papillomas with atypia (9%; 95% CI, 1-28%) at MRI-guided VAB and in two of 44 papillomas without atypia (5%; 95% CI, 0.4-16%) at MRI-guided VAB; these cancer rates did not differ significantly (p=0.6). Postmenopausal status (p=0.04) and histologic size of less than 0.2 cm (p=0.04) had a significant association with the cancer upgrade rate. Papilloma with or without atypia was found in 5% of patients who underwent MRI-guided VAB during the study period. Surgery revealed cancer in 6%. DCIS was found at surgery in 9% of lesions yielding papilloma with atypia versus 5% of lesions yielding papilloma without atypia. For lesions yielding papilloma with or without atypia at MRI-guided VAB, surgical excision is warranted.

Outcome Analysis of 9-Gauge MRI-Guided Vacuum-Assisted Core Needle Breast Biopsies

The purpose of this article is to correlate 9-gauge MRI-guided vacuum-assisted breast biopsy with surgical histologic findings to determine the upgrade rate and to correlate the frequency of MRI-guided vacuum-assisted breast biopsy cancer diagnosis with breast MRI indications and enhancement characteristics of targeted lesions. A database search was performed of all MRI-guided vacuum-assisted breast biopsies performed from January 1, 2005, to September 31, 2010. The breast MRI indications, history, age, risk factors, lesion size, enhancement characteristics, and pathologic diagnoses at MRI-guided vacuum-assisted breast biopsy and at surgery were documented. Fisher exact test and analysis of variance were used for statistical analysis. A total of 218 lesions underwent MRI-guided vacuum-assisted breast biopsy in 197 women (mean age, 52 years; range, 28-76 years), of which 85 (39%) had surgical correlation. Of the 218 lesions, 48 (22%) were malignant, 133 (61%) were benign, and 37 (17%) were high risk according to MRI-guided vacuum-assisted breast biopsy. Ten of 85 lesions (12%) were upgraded to malignancy at surgery, with a final malignancy rate of 25%. The frequency of malignancy was significantly higher in patients presenting for diagnostic (50/177 [28%]) versus screening (4/41 [10%]; p < 0.05) evaluation, patients with ipsilateral cancer (22/49 [45%]; p < 0.001), and lesions with washout kinetics (34/103 [33%]; p < 0.05) and was relatively higher in lesions with nonmasslike enhancement (26/76 [34%]; p = 0.07), which represented ductal carcinoma in situ in the majority of cases (17/26 [65%]; p < 0.005). Patients with ipsilateral cancer who have additional suspicious lesions identified on MRI require careful evaluation and biopsy to exclude additional sites of cancer that may impact surgical management.

Outcome of MRI-guided vacuum-assisted breast biopsy - initial experience at Institute of Oncology Ljubljana, Slovenia

BackgroundLike all breast imaging modalities MRI has limited specificity and the positive predictive value for lesions detected by MRI alone ranges between 15 and 50%. MRI guided procedures (needle biopsy, presurgical localisation) are mandatory for suspicious findings visible only at MRI, with potential influence on therapeutic decision. The aim of this retrospective study was to evaluate our initial clinical experience with MRI-guided vacuum-assisted breast biopsy as an alternative to surgical excision and to investigate the outcome of MRI-guided breast biopsy as a function of the MRI features of the lesions.Patients and methods.In 14 women (median age 51 years) with 14 MRI-detected lesions, MRI-guided vacuum-assisted breast biopsy was performed. We evaluated the MRI findings that led to biopsy and we investigated the core and postoperative histology results and follow-up data.ResultsThe biopsy was technically successful in 14 (93%) of 15 women. Of 14 biopsies in 14 women, core histology revealed 6 malignant (6/14, 43%), 6 benign (6/14, 43%) and 2 high-risk (2/14, 14%) lesions. Among the 6 cancer 3 were invasive and 3 were ductal carcinoma in situ (DCIS). The probability of malignancy in our experience was higher for non-mass lesion type and for washout and plateau kinetics.ConclusionsOur initial experience confirms that MRI-guided vacuum-assisted biopsy is fast, safe and accurate alternative to surgical biopsy for breast lesions detected at MRI only.

High-risk lesions diagnosed at MRI-guided vacuum-assisted breast biopsy: can underestimation be predicted?

To evaluate the frequency of diagnosis of high-risk lesions at MRI-guided vacuum-assisted breast biopsy (MRgVABB) and to determine whether underestimation may be predicted. Retrospective review of the medical records of 161 patients who underwent MRgVABB was performed. The underestimation rate was defined as an upgrade of a high-risk lesion at MRgVABB to malignancy at surgery. Clinical data, MRI features of the biopsied lesions, and histological diagnosis of cases with and those without underestimation were compared. Of 161 MRgVABB, histology revealed 31 (19%) high-risk lesions. Of 26 excised high-risk lesions, 13 (50%) were upgraded to malignancy. The underestimation rates of lobular neoplasia, atypical apocrine metaplasia, atypical ductal hyperplasia, and flat epithelial atypia were 50% (4/8), 100% (5/5), 50% (3/6) and 50% (1/2) respectively. There was no underestimation in the cases of benign papilloma without atypia (0/3), and radial scar (0/2). No statistically significant differences (p > 0.1) between the cases with and those without underestimation were seen in patient age, indications for breast MRI, size of lesion on MRI, morphological and kinetic features of biopsied lesions. Imaging and clinical features cannot be used reliably to predict underestimation at MRgVABB. All high-risk lesions diagnosed at MRgVABB require surgical excision.

Imaging–Histologic Discordance at MRI-Guided 9-Gauge Vacuum-Assisted Breast Biopsy

Imaging–Histologic Discordance at MRI-Guided 9-Gauge Vacuum-Assisted Breast Biopsy

Outcome of MRI-Guided Breast Biopsy

The objective of our study was to investigate the outcome of MRI-guided breast biopsy as a function of the indication for MRI and the MRI features of the lesions. In 154 women (mean age, 51 years) with 172 MRI-detected lesions, MRI-guided vacuum-assisted breast biopsy was attempted. Using the original radiologic report, we evaluated the indication for the original MRI examination and the MRI findings that led to biopsy. We investigated the core and operative histology results and follow-up data. We analyzed the cancer rate as a function of the indication for MRI and the MRI features of the lesions using Fisher's exact test. In 22 of the 172 lesions (13%), MRI-guided biopsy was deferred due to decreased visualization or nonvisualization of the MRI finding that led to biopsy. Of 150 biopsies in 134 women, core histology revealed 39 malignant (39/150, 26%), 90 benign (90/150, 60%), and 21 high-risk (21/150, 14%) lesions. Through operative histology (n = 13) or follow-up (n = 30), four high-risk lesions were upgraded to malignancy and all deferred lesions except four lost to follow-up were confirmed to be benign. The final number of malignancies was 43 (29%) including 16 in situ and 27 invasive cancers. The probability of malignancy was different in the screening and diagnostic settings (14% vs 36%, respectively; p = 0.05), whereas it was not different according to lesion type (mass, 34%; nonmass, 27%; focus, 19%; p > 0.05) or kinetics (persistent, 23%; plateau, 31%; washout, 29%; p > 0.05). The cancer rate in our cohort of women who underwent MRI-guided breast biopsy was 29%. It varied according to the indication for the original MRI examination, but not according to the MRI features of the lesions.

Initial clinical experience with a new MRI vacuum‐assisted breast biopsy device

To report initial clinical experience with a new previously unreported vacuum-assisted device (EnCor MR, SenoRx, Aliso Viejo, CA) for magnetic resonance imaging (MRI)-guided breast biopsy and to compare this device with previously reported technologies. A prospective study of MRI-guided vacuum-assisted breast biopsies using the EnCor device was undertaken. Lesions targeted for biopsy were occult on mammography, ultrasound, and physical examination. Histologic results were obtained for all cases. Patients with benign, concordant results underwent clinical and imaging follow-up. Cases with discordant, high-risk, or malignant results were referred for surgical biopsy. A total of 55 biopsies were performed in 47 patients. All biopsies were technically successful. Histologic results yielded malignancy in 10 (10/55, 18%) of the 55 lesions and high-risk or atypical lesions in 7 (7/55, 13%) of the cases. All of these patients have had surgical follow-up, with four (4/55, 7%) underestimations. There were three (3/55, 5%) discordant cases. 35 (35/55, 64%) lesions yielded benign concordant results. Of these, six (6/35, 17%) lesions were removed surgically, with confirmation of the MR-guided biopsy results. Twenty (20/35, 57%) lesions have undergone at least 6-month follow-up MRI, with resolution or stability of the MRI findings. The EnCor breast biopsy device has comparable results to those previously reported for other MRI-guided vacuum-assisted technologies.

Lesions Too Close to the Chest Wall: A Relative Contraindication for Vacuum-Assisted Breast Biopsy

Lesions Too Close to the Chest Wall: A Relative Contraindication for Vacuum-Assisted Breast Biopsy Vacuum-assisted breast biopsy is a minimally invasive technique with ever-growing use for the diagnosis of mammographically detected, nonpalpable breast lesions. This tech nique can be mammographically, sonographically, or MRI guided [1]. However, not all breast lesions can be sampled by vacuumassisted breast biopsy. For instance, proximity of a lesion to the chest wall has been described as a factor inhibiting the accomplishment of the stereotactic biopsy [2]. In this letter, we present our experience with a modified way of performing stereo tactic 11-gauge vacuum-assisted breast biopsy (with the patient prone on the Fischer’s table) on lesions in proximity to the chest wall. During a 19-month period (September 2005–March 2007), 38 lesions in proximity to the chest wall were sampled. It is worth mentioning that there has been no case of failure since the adoption of the modifications described for this procedure. The important steps of the modified procedure are the following. First: the plastic paddle should be removed from the Fischer’s table. Second: the arm ipsilateral to the breast to be biopsied should be stretched on and along the patient’s back (normally the hand lies at the side of the patient). During positioning of the patient, force should be exerted onto the shoulder toward the aperture of the Fischer’ table where the breast is hanging (Fig. 1). Third: to assure the stability of the arm, the woman should be informed about the problem and the modified biopsy procedure and should be encouraged to stay immobile. Fourth: the corners of the aperture of the compression paddle should be marked on the patient’s skin with a pen to ensure the immobility of the patient. In conclusion, lesions in proximity to the chest wall seem not to constitute an absolute contraindication of vacuum-assisted breast biopsy (Fig. 2). Flora Zagouri Theodoros N. Sergentanis Hippokratio Hospital University of Athens Athens, Greece George C. Zografos School of Medicine University of Athens Athens, Greece

Underestimation of Atypical Ductal Hyperplasia at MRI-Guided 9-Gauge Vacuum-Assisted Breast Biopsy

Underestimation of Atypical Ductal Hyperplasia at MRI-Guided 9-Gauge Vacuum-Assisted Breast Biopsy

4–20 Underestimation of Atypical Ductal Hyperplasia at MRI-Guided 9-Gauge Vacuum-Assisted Breast Biopsy

4–20 Underestimation of Atypical Ductal Hyperplasia at MRI-Guided 9-Gauge Vacuum-Assisted Breast Biopsy

Underestimation of DCIS at MRI-Guided Vacuum-Assisted Breast Biopsy

The study objective was to assess the rate of underestimation of ductal carcinoma in situ (DCIS) at MRI-guided 9-gauge vacuum-assisted breast biopsy. An institutional review board-approved retrospective review was performed of 373 consecutive lesions that had undergone MRI vacuum-assisted breast biopsy. In 34 lesions with subsequent surgery, vacuum-assisted breast biopsy yielded DCIS without frank microinvasion or invasion. DCIS underestimates were lesions for which vacuum-assisted breast biopsy yielded DCIS without frank microinvasion or invasion at biopsy and surgery yielded invasive cancer. Records and pathology findings were reviewed. Among 34 lesions, vacuum-assisted breast biopsy histology was DCIS in 29 and DCIS with possible microinvasion in five. Of 29 lesions yielding DCIS at MRI vacuum-assisted breast biopsy, surgical excision revealed invasive cancer in five (17%; 95% CI, 6-36%). The DCIS underestimation rate was significantly higher in lesions 6 cm or larger versus smaller lesions (60% vs 8%, p = 0.02). MRI lesion type, kinetics, number of specimens, menopausal status, and target sampling versus excision did not significantly affect underestimation. Of five lesions yielding DCIS with possible microinvasion at MRI vacuum-assisted breast biopsy, surgery revealed invasive carcinoma in four (80%; 95% CI, 28-99%). DCIS underestimation was significantly more likely if MRI vacuum-assisted breast biopsy showed possible microinvasion than if it did not (80% vs 17%, p =0.01). Underestimation occurred in 17% of lesions yielding DCIS and in 80% of lesions yielding DCIS with possible microinvasion at MRI vacuum-assisted breast biopsy. DCIS underestimation was significantly more likely in lesions measuring 6 cm or larger. No other patient or lesion factors significantly affected DCIS underestimation at MRI vacuum-assisted breast biopsy.

Underestimation of Atypical Ductal Hyperplasia at MRI-Guided 9-Gauge Vacuum-Assisted Breast Biopsy

The purposes of this study were to determine the frequency of diagnosis of atypical ductal hyperplasia (ADH) at MRI-guided 9-gauge vacuum-assisted breast biopsy and to assess the rate of underestimation of ADH at subsequent surgical excision. We conducted a retrospective review of medical records of 237 lesions consecutively detected with MRI and then subjected to MRI-guided 9-gauge vacuum-assisted breast biopsy during a 33-month period. Underestimated ADH was defined as a lesion yielding ADH at vacuum-assisted biopsy and cancer at surgery. Scientific tables were used to calculate 95% CI. Histologic analysis of MRI-guided vacuum-assisted breast biopsy specimens yielded ADH without cancer in 15 (6%) of 237 lesions. Among 15 patients in whom vacuum-assisted breast biopsy yielded ADH, the median age was 52 years (range, 46-68 years). The median number of specimens obtained was nine (range, 8-18 lesions). Median MRI lesion diameter was 1.3 cm (range, 0.7-7.0 cm). Among 15 MRI lesions, 10 (67%) were nonmasslike enhancement and five (33%) were masses. Surgical excision was performed on 13 lesions. Surgical histologic findings were malignancy in five (38%) of the cases, all ductal carcinoma in situ; high-risk lesion in six (46%) of the cases, including ADH without other high-risk lesions (n = 2), ADH and lobular carcinoma in situ (LCIS) (n = 1), ADH, LCIS, and papilloma (n =1), ADH and papilloma (n = 1), and LCIS (n = 1); and benign in two (15%) of the cases. These data indicated an ADH underestimation rate of 38% (95% CI, 14-68%). ADH without cancer was encountered in 6% of MRI-guided 9-gauge vacuum-assisted breast biopsies. ADH at MRI-guided vacuum-assisted breast biopsy is an indication for surgical excision because of the high (38%) frequency of underestimation of these lesions.

3–9 Clinical Experience With MRI-Guided Vacuum-Assisted Breast Biopsy

3–9 Clinical Experience With MRI-Guided Vacuum-Assisted Breast Biopsy

3–10 MRI-Guided 9-Gauge Vacuum-Assisted Breast Biopsy: Initial Clinical Experience

3–10 MRI-Guided 9-Gauge Vacuum-Assisted Breast Biopsy: Initial Clinical Experience

MRI-Guided Vacuum-Assisted Breast Biopsy with a Handheld Portable Biopsy System

The purpose of this study was to evaluate a compact portable 10-gauge handheld battery-operated vacuum-assisted biopsy system for MRI-guided breast biopsy. The compact portable battery-operated biopsy system can be used successfully for MRI-guided core breast biopsy and is an alternative to current systems.

MRI-Guided 9-Gauge Vacuum-Assisted Breast Biopsy: Initial Clinical Experience

The objective of this study was to evaluate our initial clinical experience with MRI-guided vacuum-assisted breast biopsy as an alternative to surgical excision. A retrospective review revealed 112 consecutive nonpalpable, mammographically occult MRI-detected breast lesions scheduled for MRI-guided vacuum-assisted biopsy. Biopsy was performed with a 9-gauge vacuum-assisted biopsy probe (Suros Surgical Systems) followed by clip placement (Artemis Medical). Medical records and histologic findings were reviewed. Among 112 lesions, biopsy was cancelled because of nonvisualization of the lesion in 14 (12%). Of the remaining 98 lesions, tissue was successfully acquired in 95 (97%). The median number of specimens obtained was 12 (range, 6-20). The median time to perform MRI-guided biopsy was 33 min for one lesion and 56 min for two lesions. Histology in 95 lesions was benign and concordant in 52 (55%), cancer in 24 (25%), high-risk in 10 (11%), and discordant in nine (9%). MRI-guided biopsy histologies in 24 cancers were ductal carcinoma in situ in 13 (54%) and infiltrating carcinoma in 11 (46%). Seven additional cancers were found at surgery in four discordant lesions and in three high-risk lesions. The clip successfully deployed in 86 (95%) of 91 lesions. Six complications (three hematomas, two instances in which the biopsy probe pierced the skin on the far side of the breast, and one vasovagal reaction) resolved without sequelae. MRI-guided vacuum-assisted biopsy is a fast and safe alternative to surgical biopsy for MRI-detected breast lesions. Imaging-histologic correlation is necessary to ensure lesion sampling.