Contrast-enhanced magnetic resonance imaging (MRI) is widely used for diagnosing various benign breast lesions. Such lesions can exhibit benign or suspicious MRI features, and may mimic malignancy. To facilitate patient care, radiologists should familiarise themselves with MRI features of benign breast lesions. This study discusses common benign breast lesions including breast cyst, fibrocystic change, breast abscess, intramammary lymph node, fat necrosis, fibroadenoma, solitary and multiple intraductal papillomas, stromal fibrosis, parenchymal scar, diabetic mastopathy, injection mammoplasty with granuloma formation, cutaneous lesion, and normal anatomic variant mimicking a mass.

Objective: Stereotactic-guided vacuum-assisted biopsy (VAB) can be performed in small breast masses, distortions, and microcalcifications. A metallic marker is deployed at the corresponding biopsy site to facilitate localisation if additional surgery is required. There is currently limited literature on the accuracy of marker placement in Asian breasts that tend to be smaller and denser than those in Caucasians. The objective of this study was to evaluate the factors that may affect marker migration in stereotactic VAB at a regional hospital in Hong Kong. Methods: From January 2010 to June 2015, all stereotactic VAB performed in the screening population at Kwong Wah Hospital were reviewed through the Hologic Selenia workstations and electronic patient records. Consensus between the local breast surgeons and radiologists defined marker migration of <1 cm as insignificant displacement. Marker migration of >1 cm could affect surgical localisation. Factors including age, indication, Breast Imaging-Reporting and Data System (BIRADS) category, needle approach, breast density, breast compression thickness, depth of the lesion, number of biopsy cuttings, complications, and duration of the procedure were recorded. The distance of marker migration from the biopsy site in cranio-caudal and mediallateral oblique views was measured. Results: A total of 154 Asian patients underwent stereotactic VAB during the study period. One patient was excluded due to technical failure during deployment of the marker. Of the remaining 153 patients, there was migration of 45 (29.4%) markers, of which 19 (12.4%) were <1 cm, 16 (10.5%) 1-3 cm, 7 (4.6%) 3-5 cm, and 3 (2.0%) >5 cm. Factors including older age, thicker breasts, greater number of biopsy cuttings, and longer duration of the procedure showed statistical significance in affecting marker migration (p < 0.05). Conclusion: This study identified four factors that could influence marker migration, namely age, breast compression thickness, number of biopsy cuttings, and duration of procedure. Awareness of these factors during the planning of the procedure could potentially decrease the effect of marker migration and thus enable more accurate surgical localisation.

Introduction:Precise preoperative localisation is essential for nonpalpable breast lesions undergoing lumpectomy. Hookwire localisation has been gradually replaced by radioisotope-guided occult lesion localisation (ROLL). We aimed to evaluate the use of magnetic metal markers (Magseed) as a nonradioactive and wireless alternative. Methods: We compared cases of Magseed localisation performed between September 2018 and April 2020 with the same number of ROLL procedures with identical pathology in the same period. Results: In total, 24 Magseed and 24 ROLL procedures were included. There were no significant differences between the case groups in terms of target characteristics, operation time, specimen size, pathological diagnosis, margin clearance, or reoperation rate. Localisation duration was significantly shorter in ROLL procedures (8.7 min) compared with Magseed localisation (12.9 min, p < 0.0001). No complications were reported. Same-day surgery was performed in all ROLL and 17 Magseed lesions. The localisation-operation interval for the other seven Magseed lesions were 4 to 14 days. Significantly lower intraoperative re-excision rates (p = 0.006) were observed in the Magseed group (8.3%) compared with the ROLL group (45.8%). Technical success of the ROLL group was 100%. Twenty-two (91.7%) Magseed localisations achieved technical success with 11/11 (100%) using ultrasound and 11/13 (84.6%) using stereotactic guidance. Magseed displacement was up to 4.8 mm in the localisation-operation interval. Conclusion: Magseed is a safe and effective localisation technique for nonpalpable breast lesions, which allows decoupling of radiological and surgical schedules.

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