MR-guided percutaneous excisional and incisional biopsy of breast lesions

The aim of this study was the realisation and clinical application of MR-guided vacuum biopsy for percutaneous excisional and incisional biopsy of enhancing breast lesions. A breast biopsy system and procedure have been developed which allow precise and safe access to breast lesions in any location and use of vacuum biopsy (VB) under MR guidance. Fifty-one patients with 55 MR-detected lesions were examined. Verification of these diagnoses included re-excision histology of all 14 malignancies and for benign lesions retrospective correlation of histology and imaging, assessment of complete or partial removal of the enhancing area directly after VB (40 of 40 lesions) and follow-up MRI (33 of 40 lesions), which in contrast to conventional needle biopsy can be used as proof of representative removal. Fifty-four of 55 procedures (including 15 lesions ≤ 5 mm and another 26 lesions of 5–10 mm size) were successful. One failure was caused by incorrect use of the VB gun. Vacuum biopsy yielded 14 malignancies and 40 benign lesions. With the available verification techniques all diagnoses proved correct. Percutaneous VB became possible under MR guidance. With minimal invasion it allowed increased certainty and accuracy even for very small lesions. Received: 17 August 1998; Revised: 15 January 1999; Accepted: 10 February 1999     

MR-guided intervention in women with a family history of breast cancer

OBJECTIVE: A study was undertaken to assess the clinical value of magnetic resonance (MR) imaging-guided interventions in women with a family history, but no personal history of breast cancer. METHODS AND PATIENTS: Retrospective review was performed on 63 consecutive women who had a family history, but no personal history of breast cancer. A total of 97 lesions were referred for an MR-guided intervention. Standardized MR examinations (1.0 T, T1-weighted 3D FLASH, 0.15 mmolGd-DTPA/kg body weight, prone position) were performed using a dedicated system which allows vacuum assisted breast biopsy or wire localization. RESULTS: Histologic findings in 87 procedures revealed 9 (10%) invasive carcinomas, 12 (14%) ductal carcinomas in situ, 2 atypical ductal hyperplasias (2.5%) and 2 atypical lobular hyperplasias (2.5%). Sixty-two (71%) benign histologic results are verified by an MR-guided intervention, retrospective correlation of imaging and histology and by subsequent follow-up. In ten lesions the indication dropped since the enhancing lesion was no longer visible. Absent enhancement was confirmed by short-term re-imaging of the noncompressed breast and by follow-up. CONCLUSION: Malignancy was found in 24%, high-risk lesions in 5% of successfully performed MR-guided biopsy procedures. A 57% of MR-detected malignancies were ductal carcinoma in situ. In 10% of the lesions the intervention was not performed, since no enhancing lesion could be reproduced at the date of anticipated intervention. Such problems may be avoided if the initial MRI is performed in the appropriate phase of the menstrual cycle and without hormonal replacement therapy.     

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

PURPOSE: 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. MATERIALS AND METHODS: 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. RESULTS: 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. CONCLUSION: The EnCor breast biopsy device has comparable results to those previously reported for other MRI-guided vacuum-assisted technologies.     

MR-guided stereotactic breast biopsy: technical aspects and preliminary results

AIM: To assess the feasibility and accuracy of cytologic and microhistologic breast biopsy using a MR imaging-guided stereotactic system with MR-compatible non-magnetic needles. MATERIALS AND METHODS: Between December 2001 and September 2002, cytologic and microhistologic sampling of 14 lesions (12 patients) was performed in our radiology department using a commercially available MR-guided stereotactic device. MR-compatible non-magnetic needles or mixed kit (non-magnetic coaxial needle + conventional ferromagnetic needle) were used. Of the 12 patients examined, 2 were undergoing MR examination because of genetic/familial risk, 4 during post-operative follow-up and the remaining 6 for contradictory mammographic and sonographic findings. Ten of the 14 lesions were visible on MR alone. The mean lesion diameter was 12 mm (range 5-30 mm). RESULTS: The procedure was relatively simple and feasible. The procedure took 45 minutes on average. The cytologic samples were adequate in 4/14 cases (29%). The diagnosis was absence of malignant cells in one case, ductal carcinoma in one case and suspected carcinoma in two cases. The cytologic diagnosis was confirmed by core biopsy, and by post-operative histology in the malignant lesions. The remaining 10/14 (71%) cytologic samples were inadequate for diagnosis. All the microhistologic samples (100%) were considered sufficient for diagnosis and yielded diagnosis of benignity in 9/14 (60%) lesions and malignancy in 5/14 (40%). Two patients with benign diagnosis underwent surgery, which confirmed the diagnosis. The remaining seven patients were evaluated by follow-up MRI; the first follow-up at 3 months showed no significant changes. Post-operative histology of the 5 lesions with malignant microhistologic diagnosis confirmed the nature of the lesions. CONCLUSIONS: MR-guided stereotactic biopsy is a simple, fast and safe procedure comparable to the interventional breast procedures performed under mammography and ultrasound guidance. The stereotactic device used ensures correct positioning of the needle into the lesion. The new dedicated non-magnetic needles and the mixed kit provide quantitatively and qualitatively adequate tissue for the histologic analysis. On the basis of our initial experience, we conclude that the procedure is feasible and accurate and can therefore be recommended for routine clinical use.     

CT-guided core needle biopsy of breast lesions visible only on MRI

OBJECTIVE: As breast MRI has become more widely used, the need to biopsy suspicious lesions visible only on MRI has increased. A small percentage of these lesions are not amenable to MR-guided biopsy. We report our technique of CT-guided core needle biopsy of breast lesions. CONCLUSION: CT-guided core needle biopsy is a safe and effective method for sampling breast lesions visible only on MRI when MR-guided biopsy is not feasible.     

介入性MR引导骨骼肌肉病变活检的应用价值

目的 介绍介入性MR引导下骨骼肌肉系统活检的技术操作方法，并评价其应用价值。方法 26例骨骼肌肉系统病变患者，均在介入性MR引导下进行经皮活检，所用设备为开放式0．23T常导MR检查仪，并配有iPath200光学引导系统(Proview，Philips)。其中10例病人术后行外科手术治疗或活检。活检针为MR兼容性。结果 24例病人获得了组织病理学诊断(24／26)。在10例后来行外科手术治疗或活检的病人中，MR活检诊断与最终诊断基本符合(10／10)。未发现明显并发症。结论 介入性MR引导下骨骼肌肉系统病变的经皮活检是1种安全、准确的新技术。     

Localization and biopsy of breast lesions by magnetic resonance imaging guidance

Contrast-enhanced MRI of the breast has proved to be a valuable tool in the detection and work-up of breast lesions. Most of these lesions are small and not visible by other imaging modalities, such as mammography or US. Thus, only MR-guided preoperative localization techniques or MR-guided percutaneous biopsy can provide a histologic work-up of such lesions. MR-guided preoperative localization seems to be a well-established procedure. However, MR-guided biopsy is still problematic. Although prototypical biopsy systems have been developed, considerable progress is still required. Problems exist with MR-guided biopsy due to severe needle artifacts and tissue shift during the intervention. Thus, needle biopsy currently is not recommended for lesions smaller than 10 mm. This work reviews current techniques for MR-guided preoperative localization and percutaneous biopsy in breast lesions. The diagnostic accuracy achievable with these techniques will be discussed, as well as the potential for new research opportunities and directions. J. Magn. Reson. Imaging 2001;13:903-911.     

Follow-up of breast lesions detected by MRI not biopsied due to absent enhancement of contrast medium

Our objective was to follow-up patients in whom scheduled MR-guided vacuum biopsies for suspicious lesions were aborted due to absent enhancement of contrast medium. Thirty-seven of 291 scheduled MR-guided vacuum biopsies were aborted. Six cases were lost to follow-up. Two could be unequivocally identified and were nevertheless biopsied. In 25 of 29 patients absent enhancement was confirmed on subsequent studies without compression. Varying hormonal or inflammatory changes between initial MRI and MR-guided vacuum biopsy most probably explain the findings. Enhancement re-appeared on short-term follow-up <6 months without compression in 4 of the 29 patients. Too strong compression during MR-guided vacuum biopsy explains the absence of enhancement in these patients. Of note, on histology, three of these cases proved malignant. We conclude that short-term follow-up without compression is necessary and recommended for all lesions not visible during scheduled MR-guided vacuum biopsy. Electronic Publication     

MRI-guided breast biopsy at 3T using a dedicated large core biopsy set: Feasibility and initial results

Objective

The increasing importance of breast MRI in the diagnostic processes concerning breast cancer yield often lesions that are visible on MRI only. To assess the nature of these lesions, pathologic analysis is necessary. Therefore, MR-guided biopsy should be available. Breast MRI at 3T has shown advantage over 1.5T. Unfortunately, current equipment for MR-guided biopsy is better suited for intervention at 1.5T due to the danger of heating titanium co-axial sleeves and large susceptibility artifacts. We evaluated a dedicated 3T breast biopsy set that uses plastic coaxial needles to overcome these problems.

Materials and methods

We performed MRI-guided breast biopsy in 23 women with 24 MRI-only visible breast lesions at 3T. Biopsy procedures were performed with plastic coaxial needles in a closed bore 3T clinical MR system on a dedicated phased array breast coil with a commercially available add-on stereotactic biopsy device.

Results

Width of the needle artifact was 2 mm in all 24 cases. Biopsy procedure was completed between 35 and 67 min. The procedure was judged moderately easy in 12 and normal in 10 cases. One procedure was judged difficult and there was one technical failure.

Conclusion

MRI-guided breast biopsy at 3T is a fast and accurate procedure. The plastic coaxial needles reduce the susceptibility artifact largely and do not increase the difficulty of the procedure. The diagnostic yield is at least equal to the diagnostic yield of the same procedure at 1.5T. Therefore, this technique can be safely used for lesions only visible at 3T MRI.     

False-negative results after stereotactically guided vacuum biopsy

The purpose of this study was to determine the false negative rate of stereotactically guided vacuum biopsy (VB). Data of patients with benign lesions in VB were evaluated retrospectively during a median follow-up period of 21 months. A total of 404 VB were considered benign and representative and were recommended for follow-up. Of these 404 lesions, 195 were completely removed radiologically. Follow-up data were available for 354/404 patients (87.6%), with intervals ranging from 3 to 66 months (median 21, mean 22.4). Reintervention or surgery was necessary in 13/354 (3.7%) cases. Of these cases, 5/354 (1.4%) turned out to be false negatives. Four of these cases showed large areas of microcalcifications or several clusters, and only partial removal was possible due to the size of the lesions.Although VB is an accurate procedure for diagnosing nonpalpable breast lesions with a low cancer miss rate, we consider the exclusion of malignancy in cases of disseminated microcalcifications or several clusters as a limitation. The radiologic-pathologic correlation in these cases is a challenge, particularly in terms of the residuals. Strict follow-up of benign lesions is essential to avoid delayed cancer diagnosis.     

Interdisciplinary consensus on the uses and technique of MR-guided vacuum-assisted breast biopsy (VAB): results of a European consensus meeting

Purpose

Quality assurance of MR-guided vacuum-assisted breast biopsy (VAB).

Method

A consensus was achieved based on the existing literature and experience of an interdisciplinary group comprising European specialists in breast imaging and VAB.

Results

Full imaging work-up must be completed according to existing standards before an indication for MR-guided VAB is established. The procedure should be reserved for lesions demonstrable by MRI alone.Acquisition of >24 cores (11-Gauge) should be routinely attempted, with the intention of sufficiently removing small lesions for accurate diagnosis.Following biopsy the patient should be re-imaged to demonstrate the biopsy site and its proximity to the lesion and hence the likely accuracy of the sampling. All patients should be discussed in a regular interdisciplinary conference and a documented consensus reached regarding patient management. Regular audit and review of all MR-guided VAB results and subsequent follow-up are recommended.

Conclusion

This consensus includes protocols for the indication, performance parameters, interdisciplinary interpretation therapeutic recommendation, documentation and follow-up of MR-guided VAB. It does not replace official recommendations for percutaneous biopsy.     

Changing role of imaging-guided percutaneous biopsy of adrenal masses: evaluation of 50 adrenal biopsies

OBJECTIVE: Prior series of percutaneous imaging-guided biopsies of adrenal masses before the advent of dedicated CT and MRI of the adrenal glands have shown that 40-57% of adrenal masses biopsied were adenomas-benign lesions requiring no further evaluation or treatment. This study was performed to assess the effect of dedicated adrenal imaging with CT and MRI on the rate of percutaneous imaging-guided biopsies of adrenal masses. MATERIALS AND METHODS: We reviewed 50 consecutive adrenal mass biopsies performed during a 48-month period. The patient demographics, technique of biopsy, pathology results, and results of any prior dedicated adrenal imaging with MRI or CT protocols were noted. RESULTS: Only six (12%) of 50 biopsies were adenomas. Five of these six cases were preceded by dedicated adrenal CT or MRI. Thirty-five cases were metastatic disease, four were adrenal cortical carcinoma, three were pheochromocytoma, and two biopsies were nondiagnostic. Overall, 20 of 50 cases were preceded by a dedicated adrenal CT or MRI examination to exclude an adenoma; in 21 of the remaining 30 cases, the imaging characteristics before biopsy were inconsistent with the potential diagnosis of an adenoma and dedicated adrenal CT or MRI was not recommended. CONCLUSION: The number of adrenal adenomas biopsied has declined markedly with the introduction of dedicated adrenal CT and MRI for adrenal adenomas. Percutaneous imaging-guided biopsy is useful in confirming the presence and nature of suspected metastatic deposits to the adrenal gland and in diagnosing or excluding adrenal adenomas in patients with equivocal imaging characteristics.     

Magnetic resonance-guided biopsy of suspicious breast lesions with a handheld vacuum biopsy device

Purpose: To evaluate a handheld vacuum-assisted device system for magnetic resonance image (MRI)-guided breast lesion biopsy.

Material and Methods: In 32 patients, a total of 42 suspicious breast lesions (mean diameter 7.5 mm for mass lesions, 11.6 mm for non-masslike diffuse lesions) seen with MRI (no suspicious changes in breast ultrasound or mammography) were biopsied (27 lateral, 15 medial) using a 10G vacuum-assisted breast biopsy device under MR guidance. Histology of biopsy specimens was compared with final histology after surgery or follow-up in benign lesions.

Results: In all biopsies, technical success was achieved. Histology revealed 11 lesions with ductal carcinoma in situ (DCIS) or invasive cancer, three with intermediate lesions (LCIS) and 28 with benign breast lesions (adenosis, infected hematoma). In one patient with discordant results of MRI and histology, surgical excision revealed medullary cancer. In the follow-up (mean 18 months) of the histological benign lesions, no breast cancer development was observed. Besides minor complications (hematoma, n = 6), with no further therapeutic interventions, no complications occurred.

Conclusion: MRI-guided breast lesion biopsy using a handheld vacuum-assisted device is a safe and effective method for the work-up of suspicious lesions seen with breast MRI without changes in mammography or ultrasound. In the case of discordant histology of vacuum biopsy and breast MRI appearance, surgical excision is recommended.     

MR imaging-guided 10-gauge vacuum-assisted breast biopsy: histological characterisation

Purpose

The aim of this study was to evaluate a handheld vacuum-assisted device for magnetic resonance imaging (MRI)-guided breast biopsy.

Materials and methods

In 47 patients, a total of 47 suspicious breast lesions (mean maximum diameter 9 mm) seen with MRI (no suspicious changes on breast ultrasound or mammography) were sampled using a 10-gauge vacuum-assisted breast biopsy (VAB) device under MRI guidance. Histology of biopsy specimens was compared with final histology after surgery or with follow-up in benign lesions.

Results

Technical success was achieved in all biopsies. Histological results from VAB revealed malignancy in 15 lesions (32%), atypical ductal hyperplasia in four lesions (8%) and benign findings in 28 lesions (60%). One of four lesions with atypical ductal hyperplasia was upgraded to ductal carcinoma in situ after surgery. One of seven lesions showing ductal carcinoma was upgraded to invasive carcinoma after surgery. Two lesions diagnosed as infiltrating carcinoma by VAB were not validated at excisional biopsy due to complete removal of the lesion during the procedure. During the follow-up (mean 18 months) of histologically benign lesions, we observed no cases of breast cancer development. Because of morphological changes on follow-up MRI scans, two lesions underwent surgical excision, which confirmed their benign nature. Besides minor complications (massive bleeding, n=1) requiring no further therapeutic intervention, no complications occurred.

Conclusions

MRI-guided biopsy of breast lesions using a handheld vacuum-assisted device is a safe and effective method for the workup of suspicious lesions seen on breast MRI alone.     

MRT-gezielte interventionelle Verfahren zur Abkl?rung des Prostatakarzinoms

In recent years magnetic resonance imaging (MRI) has been increasingly established in the diagnosis of prostate cancer in addition to transrectal ultrasonography (TRUS). The use of T2-weighted imaging allows an exact delineation of the zonal anatomy of the prostate and its surrounding structures. Other MR imaging tools, such as dynamic contrast-enhanced T1-weighted imaging or diffusion-weighted imaging allow an inference of the biochemical characteristics (multiparametric MRI). Prostate cancer, which could only be diagnosed using MR imaging or lesions suspected as being prostate cancer, which are localized in the anterior aspect of the prostate and were missed with repetitive TRUS biopsy, need to undergo MR guided biopsy. Recent studies have shown a good correlation between MR imaging and histopathology of specimens collected by MR-guided biopsy. Improved lesion targeting is therefore possible with MR-guided biopsy. So far data suggest that MR-guided biopsy of the prostate is a promising alternative diagnostic tool to TRUS-guided biopsy.     

Stereotaktische Vakuumbiopsie in liegender und sitzender Position

Purpose. The purpose of our study was to determine the accuracy of vacuum-assisted biopsy (VB) and to evaluate the side effects of this method depending on the positioning of the patient during the intervention. Methods. Interventions were performed with the 11-G biopsy needle either in prone position (Mammotest S, Fischer Imaging, USA) on a dedicated table for breast intervention (n = 308) or in upright position with a dedicated digital stereotactic mammography system (Mammomat 3000, Optima, Siemens, Germany). VB was indicated because of indeterminate or suspicious microcalcifications (84.1%) or because of dense lesions (15.9%). All benign results found with VB have been followed up after 6 and 12 months by mammography. All malignant or histological findings discordant to imaging features have been verified by open surgery. Results. Histology after VB offered 215 (64.4%) benign lesions. In neither case a carcinoma developed during follow-up. In 90 (27%) cases malignancy was found with VB. After reexcision the diagnosis of VB was confirmed in 85.6%. In 8.9% of the cases in which VB showed DCIS, histology after open surgery revealed also invasive tumor components. Technical problems occurred in 4 cases. Major side effects developed neither in prone position nor in upright, sitting position of the patient. Conclusion. VB is a reliable method with less side effects for the histiological evaluation of breast lesions. The accuracy and complications are not depending on the type of stereotactic device or on the patients position. The accuracy of the histological diagnosis achieved with VB can be compared to that of open surgery. The relative high costs of this method may cause a problem. But compared to the costs resulting by open diagnostic surgery this disadvantage is only a relative one.     

MRI-guided breast biopsy: clinical experience with 14-gauge stainless steel core biopsy needle

OBJECTIVE: Core needle biopsy has proven advantages for wire localization and excision; however, MRI-guided core biopsy has been limited by less satisfactory sampling efficiency and less availability of MRI-compatible biopsy needles. We evaluated the feasibility and diagnostic yield of MRI-guided biopsy using 14-gauge stainless steel core biopsy needles and MRI-compatible coaxial sheaths in a closed 1.5-T scanner. MATERIALS AND METHODS: Thirty-five consecutive breast biopsies performed in 29 women between March 2001 and August 2002 were retrospectively reviewed. For each procedure, an MRI-compatible sheath was placed under MRI guidance using a dedicated breast coil and biopsy guidance system. With the patient out of the magnet, a 14-gauge steel core biopsy needle was used to obtain multiple samples. Lesion characteristics, including size, morphology, and enhancement, were recorded. Histology of all the lesions was obtained; and surgical, imaging, or clinical follow-up was performed. RESULTS: Targeted masses and enhancing foci ranged from 3 to 17 mm. Regional enhancement ranged from 14 to 70 mm. Thirty-four of the 35 biopsies were technically successful. Histology revealed malignancy in eight lesions (23%), atypical ductal hyperplasia in five lesions (14%), and benign entities in 21 lesions (60%). Surgery confirmed all eight core biopsies with malignant findings. Two of five lesions with atypical ductal hyperplasia were upgraded to malignancy after surgery. CONCLUSION: This new method of MRI-guided breast biopsy with a 14-gauge stainless steel core biopsy needle and a closed 1.5-T MRI scanner is feasible, safe, and effective and produces satisfactory diagnostic yield. This method offers an alternative to MRI-guided wire localization and to MRI-guided core biopsy with nonferrous needles.     

MR-guided transgluteal biopsies with an open low-field system in patients with clinically suspected prostate cancer: technique and preliminary results

The purpose of this study was to examine the feasibility and safety of MR-guided biopsies with a transgluteal approach in patients with uncertain or suspicious prostate lesions. Twenty-five patients with uncertain or suspicious focal prostate lesions detected by high-field MR imaging of the prostate gland using endorectal coil imaging were biopsied with a transgluteal approach in a low-field MRI system (0.2 T, Concerto, Siemens). The procedures were guided using T1-weighted FLASH sequences. The prostate gland was biopsied repeatedly with a coaxial technique through a 15-gauge pencil tip with a 16-gauge biopsy handy (median 3.8 samples per patient). Complications and biopsy findings were documented retrospectively. Using T1-weighted sequences biopsy procedures were performed successfully with MR guidance in all cases without any side effects or complications. The median intervention time was 11.3 min. Pathological findings revealed ten cases of hyperplasia or atrophy, three cases of prostatitis, ten cases of carcinoma and two cases of normal tissue. The clinical follow-up showed that in two patients prostate cancer was missed at MR-guided biopsy. Transgluteal MR-guided biopsy of the prostate gland is a safe and promising approach for histological clarification of uncertain or suspicious lesions.     

Interventional MRI of the breast: lesion localisation and biopsy

With the growing use of breast MRI an increasing need exists for reliable MR-guided preoperative localisation or even MR-guided needle biopsy. In this article an overview is given of the different approaches and the present state of the art. With closed magnets the following approaches have been made: freehand localisation (similar to CT-guided freehand localisation), and freehand localisation combined with a frameless stereotaxic system operating with support by ultrasound. One localisation device for supine localisation and a thermoplastic mesh for breast stabilisation have been reported. Most investigators have used compression devices to immobilise the breast and prevent shift during needle insertion. Thus far, one immobilisation and aiming device has been designed for open magnets. A small number of experiences exist with interventions on open MR units using a navigation system. Wire localisations are presently a well-established procedure. Magnetic-resonance-guided needle biopsy has been accomplished in closed systems as well as by the use of breast immobilisation devices. However, problems still exist due to severe needle artefacts, tissue shift during the intervention and fast equalisation of contrast enhancement in lesions with surrounding tissue. Therefore, needle biopsy is not recommended for lesions < 10 mm. Magnetic-resonance-guided vacuum biopsy is somewhat more invasive but promises to solve most of these problems.