J Breast Cancer.  2014 Sep;17(3):270-278. 10.4048/jbc.2014.17.3.270.

Initial Experience with Magnetic Resonance-Guided Vacuum-Assisted Biopsy in Korean Women with Breast Cancer

• Jung HN
• Han BK
• Ko EY
• Shin JH

• KMID: 2286355
• DOI: http://doi.org/10.4048/jbc.2014.17.3.270

Abstract

PURPOSE
The aim of this study is to describe our initial experience with magnetic resonance (MR)-guided biopsy and to determine the malignancy rate of additional lesions identified by MR only in Korean women with breast cancer.
METHODS
A retrospective review identified 22 consecutive patients with breast cancer who had undergone MR-guided vacuum-assisted biopsies (VAB) of MR-only identified lesions from May 2009 to October 2011.We evaluated the rate of compliance, the technical success for MR-guided VAB and the MR imaging findings of the target lesions. VAB histology was compared with surgical histology and follow-up imaging findings.
RESULTS
The biopsy recommendations for MR-only identified lesions were accepted in 46.8% (22/47) of patients. One of 22 procedures failed due to the target's posterior location. Among 21 MR-guided VAB procedures, the target lesions were considered as a mass in 12 cases and a nonmass enhancement in nine cases. VAB histology revealed malignancies in 14% (3/21) of cases, high-risk lesions in 24% (5/21) and benign lesions in 62% (13/21). Eleven cases (52%, 11/21) had a positive surgical correlation, and one of them was upgraded from atypical ductal hyperplasia to invasive ductal carcinoma. In the remaining 10 lesions, follow-up breast ultrasound and mammography were available (range, 15-44 months; mean, 32.1 months) and did not show suspicious lesions. The final malignancy rate was 19% (4/21).
CONCLUSION
MR-guided VAB for MR-only identified lesions yielded a 19% malignancy rate in Korean women with breast cancer. MR-guided VAB helps surgeons avoid an unnecessary wide excision or additional excisional biopsy.

Keyword

Breast neoplasms; Image-guided biopsy; Interventional magnetic resonance imaging

MeSH Terms

Biopsy*
Breast
Breast Neoplasms*
Carcinoma, Ductal
Compliance
Female
Follow-Up Studies
Humans
Hyperplasia
Image-Guided Biopsy
Magnetic Resonance Imaging
Magnetic Resonance Imaging, Interventional
Mammography
Retrospective Studies
Ultrasonography

Figure

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  Figure 1 Flowchart for additional suspicious lesions on magnetic resonance imaging (MRI) in patients with breast cancer who underwent preoperative breast MRI and surgeries.US=ultrasound.

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  Figure 2 (A, B) Dedicated biopsy compression device and a commercially available compression grid-localizing system (Biopsy Positioning Device Model MR-BI-160, MRI Devices; GE Healthcare).

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  Figure 3 A method of determining the lesion location. (A, B) After reviewing the images on the console, a cursor was placed over the lesion (in a circle) and fiducial marker (in a rectangle) on the monitor. The differences in dorsal-ventral (x), cranial-caudal (y), and medial-lateral (z) direction coordinates of the lesion and fiducial marker were calculated on the basis of the spatial relationship between the lesion, vitamin E marker, and grid lines. The difference in z direction was calculated by a following formula: difference of imaging number of the lesion and fiducial marker×slice thickness of the magnetic resonance images.

• 

  Figure 4 Images of a 49-year-old woman with diagnosed as ductal carcinoma in situ (DCIS) in the left breast. (A) Initial diagnostic contrast enhanced sagittal T1-weighted 3D turbo field-echo image shows segmental enhancing lesion without washout in the mid-outer region of the contralateral (right) breast (arrow). Mammograms and second-look ultrasound did not show clear relation with magnetic resonance (MR) imaging finding. (B) Sagittal prebiopsy MR image with the same sequence reveals the tip of inserted obturator at the targeted lesion (arrow). (C) Axial MR image confirms the exact location of the tip (arrow). (D) Sagittal MR image obtained after vacuum biopsy shows air at anterior to biopsy site and lesion disappearance (arrow). (E) Overt hematoma (arrows) and echogenic air collection (arrowheads) are seen on ultrasound (US). US-guided tattooing for the vacuum-assisted biopsy site was done before the surgery. MR-guided vacuum-assisted biopsy revealed DCIS. Operation after the biopsy confirmed DCIS.

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