Management of Breast Lesions Detectable Only on MRI

Siegmann-Luz, K; Bahrs, SD; Preibsch, Heike; Hattermann, V; Claussen, Claus D.

doi:10.1055/s-0033-1335972

Cited by 7 publications

(5 citation statements)

References 45 publications

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“…The MRI-guided VAB success rate reported in the literature ranges from 87 to 98%, with some degree of procedure deferral due to absent enhancement or decreased visualisation [32][33][34][35][36]. The CEM-guided biopsy success rate in our case series was similar (95.4%).…”

Section: Discussionsupporting

confidence: 67%

Contrast-enhanced mammography-guided biopsy: technical feasibility and first outcomes

et al. 2022

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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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Section: Discussionsupporting

confidence: 67%

Contrast-enhanced mammography-guided biopsy: technical feasibility and first outcomes

et al. 2022

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“…29,30 Patients with these MRMdetected lesions should undergo a MRI-guided vacuumassisted biopsy procedure. 31 If MRI-assisted biopsy cannot be performed, either owing to the unfavourable location of a lesion or to the presence of breast implants, then MRI-guided lesion localization and subsequent surgical excision should be performed. 31 MRI-guided wire localization has been shown to enable successful localization of lesions in small cohort studies.…”

Section: Wire-guided Localizationmentioning

confidence: 99%

“…31 If MRI-assisted biopsy cannot be performed, either owing to the unfavourable location of a lesion or to the presence of breast implants, then MRI-guided lesion localization and subsequent surgical excision should be performed. 31 MRI-guided wire localization has been shown to enable successful localization of lesions in small cohort studies. [32][33][34] Difficulties in placing the wire directly into lesions has been demonstrated for lesions located directly adjacent to the chest wall or that were out of range of the localization device.…”

Section: Wire-guided Localizationmentioning

confidence: 99%

Surgical treatment of nonpalpable primary invasive and in situ breast cancer

et al. 2015

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Breast cancer is the most-common cancer among women worldwide, and over one-third of all cases diagnosed annually are nonpalpable at diagnosis. The increasingly widespread implementation of breast-screening programmes, combined with the use of advanced imaging modalities, such as magnetic resonance imaging (MRI), will further increase the numbers of patients diagnosed with this disease. The current standard management for nonpalpable breast cancer is localized surgical excision combined with axillary staging, using sentinel-lymph-node biopsy in the clinically and radiologically normal axilla. Wire-guided localization (WGL) during mammography is a method that was developed over 40 years ago to enable lesion localization preoperatively; this technique became the standard of care in the absence of a better alternative. Over the past 20 years, however, other technologies have been developed as alternatives to WGL in order to overcome the technical and outcome-related limitations of this technique. This Review discusses the techniques available for the surgical management of nonpalpable breast cancer; we describe their advantages and disadvantages, and highlight future directions for the development of new technologies.

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“…Therefore a surgical biopsy is mostly recommended [ 5 – 7 ]. Approximately 10% of all MRI-BI-RADS® 4 and BI-RADS® 5 lesions clarified by MR-VAB turn out to be B3 lesions [ 8 , 9 ]. To reduce the rate of benign surgical biopsies of MRI detected B3 lesions it would be desirable to identify low-risk and high-risk lesions before surgery.…”

Section: Introductionmentioning

confidence: 99%

Malignancy rates of B3-lesions in breast magnetic resonance imaging – do all lesions have to be excised?

Preibsch¹,

Wanner²,

Staebler

et al. 2018

BMC Med Imaging

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BackgroundApproximately 10% of all MRI-guided vacuum-assisted breast biopsies (MR-VAB) are histologically classified as B3 lesions. In most of these cases surgical excision is recommended. The aim of our study was to evaluate the malignancy rates of different B3 lesions which are visible on MRI to allow a lesion-adapted recommendation of further procedure.MethodsRetrospective analysis of 572 consecutive MR-VAB was performed. Inclusion criteria were a representative (=successful) MR-VAB, histologic diagnosis of a B3 lesion and either the existence of a definite histology after surgical excision or proof of stability or regression of the lesion on follow-up MRI. Malignancy rates were evaluated for different histologies of B3 lesions. Lesion size and lesion morphology (mass/non-mass enhancement) on MRI were correlated with malignancy.ResultsOf all MR-VAB 43 lesions fulfilled the inclusion criteria. The malignancy rate of those B3 lesions was 23.3% (10/43). The highest malignancy rate was found in atypical ductal hyperplasia (ADH) lesions (50.0%; 4/8), 33.3% (2/6) in flat epithelial atypia (FEA), 28.6% (2/7) in lobular intraepithelial neoplasia (LIN) and 12.5% (2/16) in papillary lesions (PL). All 6 complex sclerosing lesions were benign. Mass findings were significantly more frequently malignant (31.3%, 10/32; p < 0.05) than non-mass findings (0/11). Small lesions measuring 5–10 mm were most often malignant (35.0%; 7/20). All large lesions (> 20 mm) were not malignant (0/10). Intermediate sized lesions (11–20 mm) turned out to be malignant in 23.1% (3/13).ConclusionsThe malignancy rate of B3 lesions which were diagnosed after MR-VAB was 23.3%. ADH, FEA and LIN showed considerable malignancy rates (50%, 33% and 29%) and should therefore undergo surgical excision. None of the cases, which were diagnosed as radial scars, non-mass enhancement or larger lesions (> 20 mm) were malignant. Here, a follow-up MRI seems to be advisable to avoid unnecessary operations.Trial registrationRetrospective study design, waived by the IRB.

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Management of Breast Lesions Detectable Only on MRI

Cited by 7 publications

References 45 publications

Contrast-enhanced mammography-guided biopsy: technical feasibility and first outcomes

Contrast-enhanced mammography-guided biopsy: technical feasibility and first outcomes

Surgical treatment of nonpalpable primary invasive and in situ breast cancer

Malignancy rates of B3-lesions in breast magnetic resonance imaging – do all lesions have to be excised?

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