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Wang Y. 3D-printing inherently MRI-visible accessories in aiding MRI-guided biopsies. 3D Print Med 2024; 10:27. [PMID: 39102062 PMCID: PMC11299307 DOI: 10.1186/s41205-024-00227-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 07/10/2024] [Indexed: 08/06/2024] Open
Abstract
BACKGROUND 3D printers have gained prominence in rapid prototyping and viable in creating dimensionally accurate objects that are both safe within a Magnetic Resonance Imaging (MRI) environment and visible in MRI scans. A challenge when making MRI-visible objects using 3D printing is that hard plastics are invisible in standard MRI scans, while fluids are not. So typically, a hollow object will be printed and filled with a liquid that will be visible in MRI scans. This poses an engineering challenge however since objects created using traditional Fused Deposition Modeling (FDM) 3D-printing techniques are prone to leakage. Digital Light Processing (DLP) is a relatively modern and affordable 3D-printing technique using UV-hardened resin, capable of creating objects that are inherently liquid-tight. When printing hollow parts using DLP printers, one typically requires adding drainage holes for uncured liquid resin to escape during the printing process. If this is not done liquid resin will remain inside the object, which in our application is the desired outcome. PURPOSE We devised a method to produce an inherently MRI-visible accessory using DLP technology with low dimensional tolerance to facilitate MRI-guided breast biopsies. METHODS By hollowing out the object without adding drainage holes and tuning printing parameters such as z-lift distance to retain as much uncured liquid resin inside as possible through surface tension, objects that are inherently visible in MRI scans can be created without further post-processing treatment. RESULTS Objects created through our method are simple and inexpensive to recreate, have minimal manufacturing steps, and are shown to be dimensionally exact and inherently MRI visible to be directly used in various applications without further treatment. CONCLUSION Our proposed method of manufacturing objects that are inherently both MRI safe, and MRI visible. The proposed process is simple and does not require additional materials and tools beyond a DLP 3D-printer. With only an inexpensive DLP 3D-printer kit and basic cleaning and sanitation materials found in the hospital, we have demonstrated the viability of our process by successfully creating an object containing fine structures with low spatial tolerances used for MRI-guided breast biopsies.
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Affiliation(s)
- Yanlu Wang
- Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden.
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden.
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2
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Aribal E, Guldogan N, Seker ME, Yilmaz E, Turk EB. MRI only detected lesions: Can contrast enhanced mammography guided biopsy be an alternative method: Initial clinical findings. Eur J Radiol 2024; 173:111373. [PMID: 38364588 DOI: 10.1016/j.ejrad.2024.111373] [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: 10/28/2023] [Revised: 01/22/2024] [Accepted: 02/13/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVE This study aims to analyze our initial findings regarding CEM-guided stereotactic vacuum-assisted biopsy for MRI-only detected lesions and compare biopsy times by MRI-guided biopsy. MATERIALS AND METHODS In this retrospective analysis, CEM-guided biopsies of MRI-only detected breast lesions from December 2021 to June 2023were included. Patient demographics, breast density, lesion size, background parenchymal enhancement on CEM, lesion positioning, procedure duration, and number of scout views were documented. Initially, seven patients had CEM imaging before biopsy; for later cases, CEM scout views were used for simultaneous lesion depiction and targeting. RESULTS Two cases were excluded from the initial 28 patients with 29 lesions resulting in a total of 27 lesions in 26 women (mean age:44.96 years). Lesion sizes ranged from 4.5 to 41 mm, with two as masses and the remaining as non-mass enhancements. Histopathological results identified nine malignancies (33.3 %, 9/27), including invasive cancers (55.6 %, 5/9) and DCIS (44.4 %, 4/9). The biopsy PPV rate was 33.3 %. Benign lesions comprised 66.7 %, with 22.2 % high-risk lesions. The biopsy success rate was 93.1 % (27/29), and minor complications occurred in seven cases (25.9 %, 7/27), mainly small hematomas and one vasovagal reaction (3.7 %, 1/27). Median number of scout views required was 2, with no significant differences between cases with or without prior CEM (P = 0.8). Median duration time for biopsy was 14 min, significantly shorter than MRI-guided bx at the same institution (P < 0.001) by 24 min with predominantly upright positioning of the patient (88.9 %) and horizontal approach of the needle (92.6 %). CONCLUSION This study showed that CEM-guided biopsy is a feasible and safe alternative method and a faster solution for MRI-only detected enhancing lesions and can be accurately performed without the need for prior CEM imaging.
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Affiliation(s)
- Erkin Aribal
- Acibadem University, School of Medicine, Istanbul, Turkey; Acibadem Altunizade Hospital, Istanbul, Turkey.
| | | | | | - Ebru Yilmaz
- Acibadem Altunizade Hospital, Istanbul, Turkey.
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3
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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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4
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Weaver OO, Yang WT, Scoggins ME, Adrada BE, Arribas E, Moseley TW, Esquivel J, Melgar Y, Kornecki A. Challenging Contrast-Enhanced Mammography-Guided Biopsies: Practical Approach Using Real-Time Multimodality Imaging and a Proposed Procedural Algorithm. AJR Am J Roentgenol 2023; 220:512-523. [PMID: 36321982 DOI: 10.2214/ajr.22.28572] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Contrast-enhanced mammography (CEM) is an emerging functional breast imaging technique that entails the acquisition of dual-energy digital mammographic images after IV administration of iodine-based contrast material. CEM-guided biopsy technology was introduced in 2019 and approved by the U.S. FDA in 2020. This technology's availability enables direct sampling of suspicious enhancement seen only on or predominantly on recombined CEM images and addresses a major obstacle to the clinical implementation of CEM technology. The literature describing clinical indications and procedural techniques of CEM-guided biopsy is scarce. This article describes our initial experience in performing challenging CEM-guided biopsies and proposes a step-by-step procedural algorithm designed to proactively address anticipated technical difficulties and thereby increase the likelihood of achieving successful targeting.
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Affiliation(s)
- Olena O Weaver
- Department of Breast Imaging, Unit 1350, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
| | - Wei T Yang
- Department of Breast Imaging, Unit 1350, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
| | - Marion E Scoggins
- Department of Breast Imaging, Unit 1350, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
| | - Beatriz E Adrada
- Department of Breast Imaging, Unit 1350, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
| | - Elsa Arribas
- Department of Breast Imaging, Unit 1350, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
| | - Tanya W Moseley
- Department of Breast Imaging, Unit 1350, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Joanna Esquivel
- Department of Breast Imaging, Unit 1350, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
| | - Yamile Melgar
- Department of Breast Imaging, Unit 1350, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
| | - Anat Kornecki
- Department of Medical Imaging, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
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Kornecki A, Bhaduri M, Khan N, Nachum IB, Muscedere G, Shmuilovich O, Lynn K, Nano E, Blyth L. Contrast-Enhanced Mammography-Guided Breast Biopsy: Single-Center Experience. AJR Am J Roentgenol 2023; 220:826-827. [PMID: 36722757 DOI: 10.2214/ajr.22.28780] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This prospective single-center study enrolled 50 women with 51 contrast-enhanced mammography (CEM)-enhancing lesions that lacked a sonographic or mammographic correlate. Trial participants underwent CEM-guided biopsy. Biopsy was technically successful for 46 lesions and was not performed for five nonvisualized lesions (all nonmass enhancement), yielding a cancellation rate of 9.8%. Mean biopsy time was 16.6 minutes. All biopsies revealed concordant pathology (25 benign, 10 high-risk, 11 malignant). No non-visualized or benign lesion yielded malignancy at follow-up.
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Affiliation(s)
- Anat Kornecki
- Department of Medical Imaging, St. Joseph's Health Care London, 268 Grosvenor St, Rm C0-251, London, ON N6V 4V2, Canada
| | - Mousumi Bhaduri
- Department of Medical Imaging, London Health Sciences Centre, London, ON, Canada
| | - Nasir Khan
- Department of Medical Imaging, Grand River Hospital, Kitchener, ON, Canada
| | - Ilanit Ben Nachum
- Department of Medical Imaging, St. Joseph's Health Care London, 268 Grosvenor St, Rm C0-251, London, ON N6V 4V2, Canada
| | - Giulio Muscedere
- Department of Medical Imaging, St. Joseph's Health Care London, 268 Grosvenor St, Rm C0-251, London, ON N6V 4V2, Canada
| | - Olga Shmuilovich
- Department of Medical Imaging, St. Joseph's Health Care London, 268 Grosvenor St, Rm C0-251, London, ON N6V 4V2, Canada
| | - Kalan Lynn
- Department of Medical Imaging, St. Joseph's Health Care London, 268 Grosvenor St, Rm C0-251, London, ON N6V 4V2, Canada
| | - Eni Nano
- Department of Medical Imaging, St. Joseph's Health Care London, 268 Grosvenor St, Rm C0-251, London, ON N6V 4V2, Canada
| | - Lily Blyth
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON, Canada
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Park GE, Lee J, Kang BJ, Kim SH. [MRI-Guided Breast Intervention: Biopsy and Needle Localization]. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:345-360. [PMID: 37051391 PMCID: PMC10083625 DOI: 10.3348/jksr.2022.0162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/20/2023] [Accepted: 03/14/2023] [Indexed: 06/19/2023]
Abstract
In Korea, the number of institutions providing breast MRI, as well as the number of breast MRIs, has recently increased. However, MRI-guided procedures, including biopsy and needle localization, are rarely performed compared to ultrasound-guided or stereotactic biopsy. As breast MRI has high sensitivity but limited specificity, lesions detected only on MRI require pathologic confirmation through MRI-guided biopsy or surgical excision with MRI-guided needle localization. Thus, we aimed to review MRI-guided procedures, including their indications, techniques, procedural considerations, and limitations.
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7
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Özcan BB, Yan J, Xi Y, Baydoun S, Scoggins ME, Doğan BE. Performance Benchmark Metrics and Clinicopathologic Outcomes of MRI-Guided Breast Biopsies: A Systematic Review and Meta-Analysis. Eur J Breast Health 2023; 19:1-27. [PMID: 36605469 PMCID: PMC9806944 DOI: 10.4274/ejbh.galenos.2022.2022-12-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022]
Abstract
Objective To determine key performance metrics of magnetic resonance imaging (MRI)-guided breast biopsies (MRGB) to help identify reference benchmarks. Materials and Methods We identified studies reporting MRGB results up to 04.01.2021 in the Embase database, Ovid Medline (R) Process, Other Non-Indexed Citations, Ovid Medline (R) and completed a PRISMA checklist and sources of bias (QUADAS-2). The inclusion criteria were English language, available histopathological outcomes, or at least one imaging follow-up after biopsy. A random intercept logistic regression model was used to pool rates. Between-study heterogeneity was quantified by the I2 statistic. Results A total of 11,215 lesions in 50 articles were analyzed. The technical success rate was 99.10% [95% confidence interval (CI): 97.89-99.62%]. The MRI indications were staging in 1,496 (28.05%, 95% CI: 26.85-29.28%), screening in 1,427 (26.76%, 95% CI: 25.57-27.97%), surveillance in 1,027 (19.26%, 95% CI: 18.21-20.34%), diagnostic in 1,038 (19.46%, 95% CI: 18.41-20.55%), unknown primary in 74 (1.39%, 95% CI: 1.09-1.74%), and other in 271 (5.08%, 95% CI: 4.51-5.71%). Histopathology was benign in 65.06% (95% CI: 59.15-70.54%), malignant in 29.64% (95% CI: 23.58-36.52%) and high risk in 16.69% (95% CI: 9.96-26.64%). Detection of malignancy was significantly lower in those patients who underwent MRI for screening purposes (odds ratio 0.47, 95% CI: 0.25-0.87; p = 0.02), while mass lesions were more likely to yield malignancy compared to non-mass and foci [27.39% vs 11.36% (non-mass),18.03% (foci); p<0.001]. Surgical upgrade to invasive cancer occurred in 12.24% of ductal carcinoma in situ (95% CI: 7.76-18.77%) and malignancy in 15.14% of high-risk lesions (95% CI: 10.69-21.17%). MRI follow-up was performed in 1,651 (20.92%) patients after benign results [median=25 months (range: 0.4-117)]. Radiology-pathology discordance (2.48%, 95% CI: 1.62-3.77%), false negative after a benign-concordant biopsy (0.75%, 95% CI: 0.34-1.62%) and biopsy complications (2.36%, 95% CI: 2.03-2.72%) were rare. Conclusion MRGB is a highly accurate minimally-invasive diagnostic technique with low false-negative and complication rates. MRI indication and lesion type should be considered when evaluating the performance of institutional MRGB programs.
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Affiliation(s)
- Berat Bersu Özcan
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA,* Address for Correspondence: E-mail:
| | - Justin Yan
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Yin Xi
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA,Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Serine Baydoun
- Department of Radiology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Marion E. Scoggins
- Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Başak E. Doğan
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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8
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Emory T, Hoven N, Nelson M, Church AL, Rubin N, Kuehn-Hajder J. Diagnostic Contrast-Enhanced Mammography Performed Immediately Prior to Same-Day Biopsy: An Analysis of Index Lesion Enhancement Compared to Histopathology and Follow-up in Patients With Suspicious Ultrasound Findings. JOURNAL OF BREAST IMAGING 2023; 5:40-47. [PMID: 36778652 PMCID: PMC9901423 DOI: 10.1093/jbi/wbac081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Indexed: 01/03/2023]
Abstract
Objective To measure the diagnostic performance of contrast-enhanced mammography (CEM) for the index lesion when it is performed the same day prior to biopsy in patients with suspicious findings at US. Methods This IRB-approved retrospective study compared radiologist original reports of the presence or absence of index lesion enhancement on CEM to biopsy results and follow-up. The most suspicious lesion or the larger of equally suspicious lesions recommended for biopsy by US after a diagnostic workup including mammography was considered the index lesion. CEM exams were performed the same day, immediately prior to the scheduled biopsy, as requested by the radiologist recommending the biopsy. Numeric variables were summarized with means and standard deviations, or medians and the minimum and maximum, where appropriate. Results Biopsy demonstrated cancer in 64.7% (200/309) of index lesions. Of these, 197/200 demonstrated enhancement for a sensitivity of 98.5% (95% CI: 95.7%-99.7%) (197/200) and the negative predictive value of CEM for non-enhancing index lesions was 95.1% (58/61; 95% CI: 86.1%-98.4%). The three false negative exams were two grade 1 ER+ HER2- invasive ductal cancers that were 6 mm and 7 mm in size, and a 3-mm grade 2 ductal carcinoma in situ in a complex cystic and solid mass. False positive exams made up 20.6% (51/248) of the positive exams. Conclusion Diagnostic CEM showed high sensitivity and specificity for cancer in lesions with suspicious US findings. CEM may reduce the need for some biopsies, and negative CEM may support a true negative biopsy result.
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Affiliation(s)
- Tim Emory
- University of Minnesota, Department of Radiology, Minneapolis, MN, USA
| | - Noelle Hoven
- University of Minnesota, Department of Radiology, Minneapolis, MN, USA
| | - Michael Nelson
- University of Minnesota, Department of Radiology, Minneapolis, MN, USA
| | - An L Church
- University of Minnesota, Department of Radiology, Minneapolis, MN, USA
| | - Nathan Rubin
- University of Minnesota, Department of Radiology, Minneapolis, MN, USA
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9
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Contrast-enhanced mammography-guided biopsy: technical feasibility and first outcomes. Eur Radiol 2022; 33:417-428. [PMID: 35895121 DOI: 10.1007/s00330-022-09021-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/23/2022] [Accepted: 06/30/2022] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To evaluate the feasibility of contrast-enhanced mammography (CEM)-guided biopsy at Hospital del Mar, a Spanish university hospital. METHODS We retrospectively reviewed all consecutive women with a suspicious enhancing finding eligible for CEM-guided biopsy, who were prospectively enrolled in a pre-marketing clinical validation and feasibility study (October 2019 to September 2021). CEM-guided biopsy is a stereotactic-based procedure that, by using intravenous iodinated contrast media administration and dual-energy acquisition, provides localisation of enhancing lesions. All the biopsies were performed using a vacuum-assisted device. We collected procedural characteristics (patient position and type of approach), and histopathological results. Feasibility endpoints included success (visualisation of the enhancing lesion, post-procedural biopsy changes and clip placement), procedural time, number of scout acquisitions and complications. RESULTS A total of 66 suspicious enhancing lesions (18.0% foci, 44.0% mass, 38.0% non-mass enhancement; median size 8.5 mm) in 64 patients (median age 59 years, mostly minimal [48.4%] or mild [32.8%] background parenchymal enhancement) were referred for CEM-guided biopsy in the study period. The success rate was 63/66 (95.4%). Amongst successful procedures, patients were most frequently seated (52/63, 82.5%) and the preferred approach was horizontal (48/63, 76.2%). Median total time per procedure was 15 min. Median number of acquisitions needed before targeting was 2 (range 1-4). Complications consisted of hematoma (17/63, 27%) and vasovagal reaction (2/63, 3.2%). At histology, the malignancy rate was 25/63 (39.7%). CONCLUSION In this first patient series, CEM-guided breast biopsy was feasible, with success and complication rates similar to those previously reported for magnetic resonance guidance. KEY POINTS • CEM may be used to guide biopsy of enhancing lesions through a stereotactic-based procedure combined with intravenous iodinated contrast media administration and dual-energy acquisition. • In this first patient series (n = 64), the success rate of CEM-guided biopsy was above 95%, the only complications were hematoma (22.2%) and vasovagal reaction (3.2%), and median total time per procedure was 15 min. • CEM-guided biopsy is feasible and could potentially be a widely available biopsy technique for enhancing-only lesions.
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Adrada BE, Guirguis MS, Hoang T, Spak DA, Rauch GM, Moseley TW. MRI-guided Breast Biopsy Case-based Review: Essential Techniques and Approaches to Challenging Cases. Radiographics 2022; 42:E46-E47. [PMID: 35119965 PMCID: PMC8906341 DOI: 10.1148/rg.210126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
MRI-guided breast biopsy is often necessary to distinguish between benign and
malignant lesions depicted at MRI, and meticulous preparation and
radiologic-pathologic correlation aid in definitive diagnosis.
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Affiliation(s)
- Beatriz E. Adrada
- From the Departments of Breast Imaging (B.E.A., M.S.G., D.A.S., G.M.R., T.W.M.), Interventional Radiology (T.H.), Abdominal Imaging (G.M.R.), and Surgical Oncology (T.W.M.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1350, Houston, TX 77030. T.W.M. has provided disclosures (see end of article); all other authors have disclosed no relevant relationships
| | - Mary S. Guirguis
- From the Departments of Breast Imaging (B.E.A., M.S.G., D.A.S., G.M.R., T.W.M.), Interventional Radiology (T.H.), Abdominal Imaging (G.M.R.), and Surgical Oncology (T.W.M.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1350, Houston, TX 77030. T.W.M. has provided disclosures (see end of article); all other authors have disclosed no relevant relationships
| | - Tuan Hoang
- From the Departments of Breast Imaging (B.E.A., M.S.G., D.A.S., G.M.R., T.W.M.), Interventional Radiology (T.H.), Abdominal Imaging (G.M.R.), and Surgical Oncology (T.W.M.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1350, Houston, TX 77030. T.W.M. has provided disclosures (see end of article); all other authors have disclosed no relevant relationships
| | - David A. Spak
- From the Departments of Breast Imaging (B.E.A., M.S.G., D.A.S., G.M.R., T.W.M.), Interventional Radiology (T.H.), Abdominal Imaging (G.M.R.), and Surgical Oncology (T.W.M.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1350, Houston, TX 77030. T.W.M. has provided disclosures (see end of article); all other authors have disclosed no relevant relationships
| | - Gaiane M. Rauch
- From the Departments of Breast Imaging (B.E.A., M.S.G., D.A.S., G.M.R., T.W.M.), Interventional Radiology (T.H.), Abdominal Imaging (G.M.R.), and Surgical Oncology (T.W.M.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1350, Houston, TX 77030. T.W.M. has provided disclosures (see end of article); all other authors have disclosed no relevant relationships
| | - Tanya W. Moseley
- From the Departments of Breast Imaging (B.E.A., M.S.G., D.A.S., G.M.R., T.W.M.), Interventional Radiology (T.H.), Abdominal Imaging (G.M.R.), and Surgical Oncology (T.W.M.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1350, Houston, TX 77030. T.W.M. has provided disclosures (see end of article); all other authors have disclosed no relevant relationships
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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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Gao P, Kong X, Song Y, Song Y, Fang Y, Ouyang H, Wang J. Recent Progress for the Techniques of MRI-Guided Breast Interventions and their applications on Surgical Strategy. J Cancer 2020; 11:4671-4682. [PMID: 32626513 PMCID: PMC7330700 DOI: 10.7150/jca.46329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 05/09/2020] [Indexed: 01/20/2023] Open
Abstract
With a high sensitivity of breast lesions, MRI can detect suspicious lesions which are occult in traditional breast examination equipment. However, the lower and variable specificity of MRI makes the MRI-guided intervention, including biopsies and localizations, necessary before surgery, especially for patients who need the treatment of breast-conserving surgery (BCS). MRI techniques and patient preparation should be first carefully considered before the intervention to avoid lengthening the procedure time and compromising targeting accuracy. Doctors and radiologists need to reconfirm the target of the lesion and be very familiar with the process approach and equipment techniques involving the computer-aided diagnosis (CAD) tools and the biopsy system and follow a correct way. The basic steps of MRI-guided biopsy and localization are nearly the same regardless of the vendor or platform, and this article systematically introduces detailed methods and techniques of MRI-guided intervention. The two interventions both face different challenging situations during procedures with solutions given in the article. Post-operative statistics show that the complications of MRI-guided intervention are infrequent and mild, and MRI-guided biopsy provides the pathological information for the subsequent surgical decisions and MRI-guided localization fully prepared for follow-up surgical biopsy. New techniques for MRI-guided intervention are also elaborated in the article, which leads to future development. In a word, MRI-guided intervention is a safe, accurate, and effective technique with a low complication rate and successful MRI-guided intervention is truly teamwork with efforts from patients to surgeons, radiologists, MRI technologists, and nurses.
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Affiliation(s)
- Peng Gao
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Xiangyi Kong
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Ying Song
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yan Song
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yi Fang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Han Ouyang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jing Wang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
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Wang J, Song Y, Liu J, Meng X, Xing Z, Zhang M, Ye F, Wang X, Wang X. Clinical Application and Feasibility of MRI-Guided Breast Biopsy of Breast Minimal Lesions in Chinese Population. Front Oncol 2020; 10:257. [PMID: 32211320 PMCID: PMC7067823 DOI: 10.3389/fonc.2020.00257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 02/14/2020] [Indexed: 12/16/2022] Open
Abstract
Objectives: Some breast lesions are not visible on mammography or ultrasonography, and magnetic resonance imaging (MRI) become the only way to monitor these lesions. The purpose of this study was to evaluate the clinical application of MRI-guided biopsy and MRI-guided wire localization of breast minimal lesions in Chinese population. Methods: We evaluated 95 patients (the most patients of known in China) from August 2013 to December 2017. All the patients were scanned with a 1.5-Tesla MRI system (GE Medical Systems, America) in the prone position using a bilateral 8-channel phased-array breast coil and underwent MRI-guided wire localization or MRI-guided biopsy. Results: MRI-guided wire localization and MRI-guided biopsy were successfully performed in 87 patients with 88 lesions (100%, 88/88). After biopsy or surgery, 36 of 88 lesions (40.91%) were malignant, and 52 of 88 lesions (59.09%) were benign. Thirty-nine of 88 lesions (44.32%) were masses, and 49 of 88 (55.68%) showed non-mass enhancement. Statistical analysis showed there was no significant correlation between the malignancy rate and the type of lesion on MRI (P = 0.27). In this study, the rate of malignancy for Breast Imaging-Reporting and Data System (BI-RADS) 5 lesions was 100% (2 of 2) compared with 44.44% for BI-RADS 4C lesions (4 of 9), 42.42% for BI-RADS 4B lesions (14 of 33), and 36.36% for BI-RADS 4A lesions (16 of 44). Conclusions: MRI-guided wire localization with subsequent surgical biopsy and MRI-guided biopsy are safe and effective tools for breast minimal lesions.
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Affiliation(s)
- Jie Wang
- Department of Ultrasound, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Song
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiaqi Liu
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiangzhi Meng
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zeyu Xing
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Menglu Zhang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Feng Ye
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xin Wang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiang Wang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Abstract
OBJECTIVE. The purpose of this article is to review the literature regarding image-guided breast procedures, including helpful tips and tricks to guide the practicing interventional breast radiologist. CONCLUSION. The successful diagnosis and treatment of breast cancer involves coordination of the multidisciplinary breast team. Optimal procedural skills for image-guided biopsy and preoperative lesion localization are paramount to the radiologists' success.
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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: 9] [Impact Index Per Article: 1.5] [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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Neal CH. Lesion Nonvisualization at MRI-Guided Breast Biopsy: Now What? Acad Radiol 2018; 25:1099-1100. [PMID: 30064920 DOI: 10.1016/j.acra.2018.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 06/06/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Colleen H Neal
- Department of Radiology, University of Michigan Health System, C415 MIB SPC 5842, 1500 E. Medical Center Drive, Ann Arbor, MI 48109.
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Papalouka V, Kilburn-Toppin F, Gaskarth M, Gilbert F. MRI-guided breast biopsy: a review of technique, indications, and radiological-pathological correlations. Clin Radiol 2018; 73:908.e17-908.e25. [PMID: 30041954 DOI: 10.1016/j.crad.2018.05.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 05/24/2018] [Indexed: 10/28/2022]
Abstract
Breast magnetic resonance imaging (MRI) is the technique of choice in detection, local staging, and monitoring of breast cancer; however, breast MRI results in the detection of more indeterminate/suspicious lesions that need to be histopathologically proven to guide patient management than any other breast imaging method. If such abnormalities are not detectable in any of the conventional imaging tools (mammography (MMG) or ultrasound) then an MRI-guided biopsy needs to be performed to obtain a diagnosis. Breast MRI-guided biopsy is a time-consuming and complex procedure that requires specific equipment and experienced, well-trained staff. This review article explores and illustrates the indications, the currently available technologies, and the technique of breast MRI-guided biopsy, and explains the importance of careful imaging review and selection of cases. We correlate the radiological-pathological findings and highlight the impact on patient management in a multidisciplinary setting.
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Affiliation(s)
- V Papalouka
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, UK
| | - F Kilburn-Toppin
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, UK.
| | - M Gaskarth
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, UK
| | - F Gilbert
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, UK
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18
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Heller SL, Young Lin LL, Melsaether AN, Moy L, Gao Y. Hormonal Effects on Breast Density, Fibroglandular Tissue, and Background Parenchymal Enhancement. Radiographics 2018; 38:983-996. [DOI: 10.1148/rg.2018180035] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Samantha L. Heller
- From the Department of Radiology, New York University School of Medicine, 160 E 34th St, New York, NY 10016
| | - Leng Leng Young Lin
- From the Department of Radiology, New York University School of Medicine, 160 E 34th St, New York, NY 10016
| | - Amy N. Melsaether
- From the Department of Radiology, New York University School of Medicine, 160 E 34th St, New York, NY 10016
| | - Linda Moy
- From the Department of Radiology, New York University School of Medicine, 160 E 34th St, New York, NY 10016
| | - Yiming Gao
- From the Department of Radiology, New York University School of Medicine, 160 E 34th St, New York, NY 10016
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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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20
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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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21
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McGrath AL, Price ER, Eby PR, Rahbar H. MRI-guided breast interventions. J Magn Reson Imaging 2017; 46:631-645. [PMID: 28470744 DOI: 10.1002/jmri.25738] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 03/21/2017] [Indexed: 12/26/2022] Open
Abstract
Magnetic resonance imaging (MRI)-guided interventions, including biopsies and wire localizations, are fundamental to any breast imaging practice due to the high sensitivity but limited specificity of breast MRI. The basic steps of MRI-guided biopsies are similar regardless of the vendor or platform, and technical considerations include approach planning, patient preparation and positioning, lesion targeting, and directional sampling using a vacuum-assisted biopsy technique. Unique challenges related to MRI-guided biopsies include vanishing lesions due to contrast washout, obscuration of the biopsy site due to susceptibility artifacts, and limited access to posteromedial lesions. A careful approach to planning, patient positioning, and lesion targeting will maximize the chances for a successful biopsy. Due to overlapping imaging features between benign and malignant lesions, radiologic-pathologic concordance is difficult and essential for further patient management. LEVEL OF EVIDENCE 5 Technical Efficacy: Stage 3 J. MAGN. RESON. IMAGING 2017;46:631-645.
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Affiliation(s)
- Anika L McGrath
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Elissa R Price
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Peter R Eby
- Department of Radiology, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Habib Rahbar
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington, USA.,Breast Imaging, Seattle Cancer Care Alliance, Seattle, Washington, USA
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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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23
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Chevrier MC, David J, Khoury ME, Lalonde L, Labelle M, Trop I. Breast Biopsies Under Magnetic Resonance Imaging Guidance: Challenges of an Essential but Imperfect Technique. Curr Probl Diagn Radiol 2016; 45:193-204. [DOI: 10.1067/j.cpradiol.2015.07.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 07/02/2015] [Indexed: 11/22/2022]
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Affiliation(s)
- Sonya Bhole
- Caldwell Breast Center, Lutheran General Hospital
| | - Erin Neuschler
- Northwestern Memorial Hospital
- The Lynn Sage Comprehensive Breast Center, Prentice Women’s Hospital
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Uematsu T, Takahashi K, Nishimura S, Watanabe J, Yamasaki S, Sugino T, Oishi T, Kakuda Y, Sato M, Hayashi T. Real-time virtual sonography examination and biopsy for suspicious breast lesions identified on MRI alone. Eur Radiol 2015; 26:1064-72. [PMID: 26135000 DOI: 10.1007/s00330-015-3892-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 06/10/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The purpose of our study was to assess whether there is a potential additional value of real-time virtual sonography (RVS) to second-look ultrasound (US) examination and biopsy for breast lesions identified on MRI alone. METHODS A retrospective review of the records of 70 consecutive patients (78 lesions) with breast abnormalities identified on MRI alone was performed. All suspicious enhancing lesions were subsequently evaluated with second-look US. Lesions not observed on second-look US underwent RVS. Pathological findings were confirmed by subsequent percutaneous biopsy or excision. RESULTS Of the 78 MRI-detected lesions, second-look US correlation was made in 50 (64 %), including 22 malignant and 28 benign lesions. The remaining 28 lesions (36 %) were scheduled to undergo RVS. Four lesions were not visible on the second breast MRI. The remaining 24 lesions were RVS correlated and underwent RVS-guided biopsy; these included seven malignant and 17 benign lesions. Overall, 74 of 74 (100 %) true MRI-detected lesions were confirmed by histological results without using MRI-guided breast biopsy. The cancer rate was 29 %. CONCLUSIONS RVS can increase the sonographic detection and biopsy rate of lesions identified on breast MRI alone. KEY POINTS • All 74 MRI-detected lesions were confirmed without using MRI-guided biopsy. • Four lesions were not visible on second breast MRI. • RVS can increase sonographic detection of lesions identified on breast MRI alone. • RVS-guided breast biopsy can be an alternative to MRI-guided biopsy.
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Affiliation(s)
- Takayoshi Uematsu
- Breast Imaging and Breast Intervention Section, Department of Clinical Physiology, Shizuoka Cancer Center Hospital, Naga-izumi, Shizuoka, 411-8777, Japan.
| | - Kaoru Takahashi
- Department of Breast Surgery, Shizuoka Cancer Center Hospital, Naga-izumi, Shizuoka, 411-8777, Japan
| | - Seiichiro Nishimura
- Department of Breast Surgery, Shizuoka Cancer Center Hospital, Naga-izumi, Shizuoka, 411-8777, Japan
| | - Junichiro Watanabe
- Department of Breast Oncology, Shizuoka Cancer Center Hospital, Naga-izumi, Shizuoka, 411-8777, Japan
| | - Seiji Yamasaki
- Department of Multidisciplinary Therapy for Breast Cancer, Shizuoka Cancer Center Hospital, Naga-izumi, Shizuoka, 411-8777, Japan
| | - Takashi Sugino
- Department of Pathology, Shizuoka Cancer Center Hospital, Naga-izumi, Shizuoka, 411-8777, Japan
| | - Takuma Oishi
- Department of Pathology, Shizuoka Cancer Center Hospital, Naga-izumi, Shizuoka, 411-8777, Japan
| | - Yuko Kakuda
- Department of Pathology, Shizuoka Cancer Center Hospital, Naga-izumi, Shizuoka, 411-8777, Japan
| | - Mutsu Sato
- Department of Breast Surgery, Shizuoka Cancer Center Hospital, Naga-izumi, Shizuoka, 411-8777, Japan
| | - Tomomi Hayashi
- Department of Breast Surgery, Shizuoka Cancer Center Hospital, Naga-izumi, Shizuoka, 411-8777, Japan
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26
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Clinical significance of magnetic resonance imaging-guided core needle biopsies. Top Magn Reson Imaging 2014; 23:355-60. [PMID: 25463405 DOI: 10.1097/rmr.0000000000000038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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