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Feasibility of MRI-guided large-core-needle biopsy of suspiscious breast lesions at 3 T.

Peters NH, Meeuwis C, Bakker CJ, Mali WP, Fernandez-Gallardo AM, van Hillegersberg R, Schipper ME, van den Bosch MA - Eur Radiol (2009)

Bottom Line: Tissue sampling was technically successful in 29/31 (94%) lesions.Histopathological analysis showed 19 benign lesions (66%) and one inconclusive biopsy result (3%).Follow-up MRI at 6 months after the biopsy should be performed in case of a benign biopsy result.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, E.01.132, 3584 CX, Utrecht, The Netherlands. n.peters@umcutrecht.nl

ABSTRACT
The feasibility of large-core-needle magnetic resonance imaging (MRI)-guided breast biopsy at 3 T was assessed. Thirty-one suspicious breast lesions shown only by MRI were detected in 30 patients. Biopsy procedures were performed in a closed-bore 3-T clinical MR system on a dedicated phased-array breast coil with a commercially available add-on stereotactic biopsy device. Tissue sampling was technically successful in 29/31 (94%) lesions. Median lesion size (n = 29) was 9 mm. Histopathological analysis showed 19 benign lesions (66%) and one inconclusive biopsy result (3%). At follow-up of these lesions, 15 lesions showed no malignancy, no information was available in three patients and two lesions turned out to be malignant (one lesion at surgical excision 1 month after biopsy and one lesion at a second biopsy because of a more malignant enhancement curve at 12-months follow-up MRI). Nine biopsy results showed a malignant lesion (31%) which were all surgically removed. No complications occurred. MRI-guided biopsy at 3 T is a safe and effective method for breast biopsy in lesions that are occult on mammography and ultrasound. Follow-up MRI at 6 months after the biopsy should be performed in case of a benign biopsy result.

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Stereotactic system for MRI-guided preoperative wire-localization and breast biopsy. This system consists of a breast coil, which can be used for diagnostic MRI of the breast, and an add-on stereotactic device. The breast is compressed by two compression plates. The system allows angulation of the needle
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Fig1: Stereotactic system for MRI-guided preoperative wire-localization and breast biopsy. This system consists of a breast coil, which can be used for diagnostic MRI of the breast, and an add-on stereotactic device. The breast is compressed by two compression plates. The system allows angulation of the needle

Mentions: Second-look ultrasound was recommended in all patients; if the lesion could be retrieved on ultrasound images, ultrasound-guided biopsy was performed; if the lesion was occult on ultrasound images, MRI-guided biopsy was performed. MRI-guided biopsies were performed on a 3-T clinical MR system (Achieva, Philips Healthcare, Best, The Netherlands). Patients were placed in the prone position in a dedicated phased-array bilateral breast coil, with the affected breast in a dedicated breast coil which had an add-on biopsy device with a medial and lateral compression plate (Fig. 1) (MRI Devices, Würzburg, Germany). The biopsy system comprised a gadolinium-filled guiding marker tube that can be positioned in the feet-head and anterior-posterior direction along a centimeter scale and angulated around the feet-head axis from +45° to -45° degrees. First, fat-suppressed high-resolution T1-weighted gradient-echo images were acquired after the administration of 0.1 mmol/kg gadolinium (Magnevist, Bayer-Schering, Germany) to verify the position of the lesion. The administration of the contrast agent was delayed as long as possible during the procedure to avoid vanishing of the target lesion. The main parameters of this MR sequence are listed in Table 1. After correct positioning of the marker tube, the table top was moved out of the bore and local anesthesia (lidocaine 1%) was administered subcutaneously. The marker tube was replaced by a 14-gauge sterile biopsy needle surrounded by a 13-gauge needle holder (Somatex, Teltow, Germany). The needle and sheath were horizontally inserted in the breast and advanced towards the lesion. The position of the needle and sheath were confirmed by using the fat-suppressed high-resolution T1-weighted gradient-echo sequence. After correct placement of the biopsy needle was confirmed, the 14-gauge biopsy gun (Somatex, Teltow, Germany) was inserted through the sheath and three to five tissue samples were obtained.Fig. 1


Feasibility of MRI-guided large-core-needle biopsy of suspiscious breast lesions at 3 T.

Peters NH, Meeuwis C, Bakker CJ, Mali WP, Fernandez-Gallardo AM, van Hillegersberg R, Schipper ME, van den Bosch MA - Eur Radiol (2009)

Stereotactic system for MRI-guided preoperative wire-localization and breast biopsy. This system consists of a breast coil, which can be used for diagnostic MRI of the breast, and an add-on stereotactic device. The breast is compressed by two compression plates. The system allows angulation of the needle
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2691521&req=5

Fig1: Stereotactic system for MRI-guided preoperative wire-localization and breast biopsy. This system consists of a breast coil, which can be used for diagnostic MRI of the breast, and an add-on stereotactic device. The breast is compressed by two compression plates. The system allows angulation of the needle
Mentions: Second-look ultrasound was recommended in all patients; if the lesion could be retrieved on ultrasound images, ultrasound-guided biopsy was performed; if the lesion was occult on ultrasound images, MRI-guided biopsy was performed. MRI-guided biopsies were performed on a 3-T clinical MR system (Achieva, Philips Healthcare, Best, The Netherlands). Patients were placed in the prone position in a dedicated phased-array bilateral breast coil, with the affected breast in a dedicated breast coil which had an add-on biopsy device with a medial and lateral compression plate (Fig. 1) (MRI Devices, Würzburg, Germany). The biopsy system comprised a gadolinium-filled guiding marker tube that can be positioned in the feet-head and anterior-posterior direction along a centimeter scale and angulated around the feet-head axis from +45° to -45° degrees. First, fat-suppressed high-resolution T1-weighted gradient-echo images were acquired after the administration of 0.1 mmol/kg gadolinium (Magnevist, Bayer-Schering, Germany) to verify the position of the lesion. The administration of the contrast agent was delayed as long as possible during the procedure to avoid vanishing of the target lesion. The main parameters of this MR sequence are listed in Table 1. After correct positioning of the marker tube, the table top was moved out of the bore and local anesthesia (lidocaine 1%) was administered subcutaneously. The marker tube was replaced by a 14-gauge sterile biopsy needle surrounded by a 13-gauge needle holder (Somatex, Teltow, Germany). The needle and sheath were horizontally inserted in the breast and advanced towards the lesion. The position of the needle and sheath were confirmed by using the fat-suppressed high-resolution T1-weighted gradient-echo sequence. After correct placement of the biopsy needle was confirmed, the 14-gauge biopsy gun (Somatex, Teltow, Germany) was inserted through the sheath and three to five tissue samples were obtained.Fig. 1

Bottom Line: Tissue sampling was technically successful in 29/31 (94%) lesions.Histopathological analysis showed 19 benign lesions (66%) and one inconclusive biopsy result (3%).Follow-up MRI at 6 months after the biopsy should be performed in case of a benign biopsy result.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, E.01.132, 3584 CX, Utrecht, The Netherlands. n.peters@umcutrecht.nl

ABSTRACT
The feasibility of large-core-needle magnetic resonance imaging (MRI)-guided breast biopsy at 3 T was assessed. Thirty-one suspicious breast lesions shown only by MRI were detected in 30 patients. Biopsy procedures were performed in a closed-bore 3-T clinical MR system on a dedicated phased-array breast coil with a commercially available add-on stereotactic biopsy device. Tissue sampling was technically successful in 29/31 (94%) lesions. Median lesion size (n = 29) was 9 mm. Histopathological analysis showed 19 benign lesions (66%) and one inconclusive biopsy result (3%). At follow-up of these lesions, 15 lesions showed no malignancy, no information was available in three patients and two lesions turned out to be malignant (one lesion at surgical excision 1 month after biopsy and one lesion at a second biopsy because of a more malignant enhancement curve at 12-months follow-up MRI). Nine biopsy results showed a malignant lesion (31%) which were all surgically removed. No complications occurred. MRI-guided biopsy at 3 T is a safe and effective method for breast biopsy in lesions that are occult on mammography and ultrasound. Follow-up MRI at 6 months after the biopsy should be performed in case of a benign biopsy result.

Show MeSH
Related in: MedlinePlus