MRI-Guided Breast Biopsy: Outcomes and Effect on Patient Management

Myers, Kelly; Kamel, Ihab R.; Macura, Katarzyna J.

doi:10.1016/j.clbc.2014.11.003

Cited by 24 publications

(16 citation statements)

References 27 publications

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“…Furthermore, many published reports on DWI have excluded lesion subgroups in most need of improved diagnostic characterization. These subtypes include lesions smaller than 10–12 mm, which account for over half of MRI findings (28) and are more likely than larger lesions to be a false-positive (28,29), and less well-defined non-mass enhancement (NME) lesions (30–32), which require an expensive MRI-guidance procedure for sampling more often than masses (33).…”

Section: Introductionmentioning

confidence: 99%

Utility of Diffusion-weighted Imaging to Decrease Unnecessary Biopsies Prompted by Breast MRI: A Trial of the ECOG-ACRIN Cancer Research Group (A6702)

Rahbar

Zhang

Chenevert

et al. 2019

Clinical Cancer Research

110

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Purpose: Conventional breast MRI is highly sensitive for cancer detection but prompts some false-positives. We performed a prospective, multicenter study to determine whether apparent diffusion coefficients (ADCs) from diffusion weighted imaging (DWI) can decrease MRI false-positives. Experimental Design: 107 women with MRI-detected BI-RADS 3, 4, or 5 lesions were enrolled from March 2014 to April 2015. ADCs were measured both centrally and at participating sites. Receiver operating characteristic (ROC) analysis was employed to assess diagnostic performance of centrally-measured ADCs and identify optimal ADC thresholds to reduce unnecessary biopsies. Lesion reference standard was based on either definitive biopsy result or at least 337 days of follow-up after the initial MRI procedure. Results: Of 107 women enrolled, 67 patients (median age 49, range 24–75 years) with 81 lesions with confirmed reference standard (28 malignant, 53 benign) and evaluable DWI were analyzed. 67/81 lesions were BI-RADS 4 (n=63) or 5 (n=4) and recommended for biopsy. Malignancies exhibited lower mean centrally-measured ADCs (mm2/s) than benign lesions (1.21×10−3 vs.1.47×10−3, p<0.0001, area under ROC curve=0.75, 95% confidence interval [CI] 0.65–0.84). In centralized analysis, application of an ADC threshold (1.53×10−3 mm2/s) lowered the biopsy rate by 20.9% (14/67; 95% CI 11.2–31.2%) without affecting sensitivity. Application of a more conservative threshold (1.68×10−3mm2/s) to site-derived ADCs reduced the biopsy rate by 26.2%(16/61) but missed three cancers. Conclusion: DWI can re-classify a substantial fraction of suspicious breast MRI findings as benign and thereby decrease unnecessary biopsies. ADC thresholds identified in this trial should be validated in future Phase III studies.

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Section: Introductionmentioning

confidence: 99%

Utility of Diffusion-weighted Imaging to Decrease Unnecessary Biopsies Prompted by Breast MRI: A Trial of the ECOG-ACRIN Cancer Research Group (A6702)

Rahbar

Zhang

Chenevert

et al. 2019

Clinical Cancer Research

110

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“…The malignancy rate in this study of women with MRI-visible breast lesions who underwent MRI-guided wire localization with subsequent surgical biopsy and MRI-guided biopsy of breast minimal lesions was 40.91% (in 13 patients who underwent MRI-guided biopsy, the malignancy rate was 23.08%, and in 74 patients with 75 eligible lesions who underwent MRI-guided wire localization with surgical biopsy, the malignancy rate was 44.0%), which is higher than the reported range of 20-35% (22)(23)(24)(25). The main difference in this study was that the majority of patients (n = 74) underwent MRI-guided wire localization with subsequent surgical biopsy (the number of suspicious lesions was 75), and only 13 patients underwent MRI-guided biopsy.…”

Section: Discussionmentioning

confidence: 70%

Clinical Application and Feasibility of MRI-Guided Breast Biopsy of Breast Minimal Lesions in Chinese Population

et al. 2020

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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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“…For cases that have been assessed as possibly missed or discordant, a repeat biopsy or surgical excision is recommended. MRI-guided core biopsy malignancy rates varying between 16-40.91% have been reported [4,32,41,[98][99][100][101]. For benign-concordant lesions, a diagnostic follow-up MRI after 6 months of MRI-guided interventions is recommended due to the risk of false-negative results [18,50].…”

Section: Perspectives and Conclusionmentioning

confidence: 99%

Recent Progress for the Techniques of MRI-Guided Breast Interventions and their applications on Surgical Strategy

Gao¹,

Kong²,

Song³

et al. 2020

J. Cancer

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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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MRI-Guided Breast Biopsy: Outcomes and Effect on Patient Management

Cited by 24 publications

References 27 publications

Utility of Diffusion-weighted Imaging to Decrease Unnecessary Biopsies Prompted by Breast MRI: A Trial of the ECOG-ACRIN Cancer Research Group (A6702)

Utility of Diffusion-weighted Imaging to Decrease Unnecessary Biopsies Prompted by Breast MRI: A Trial of the ECOG-ACRIN Cancer Research Group (A6702)

Clinical Application and Feasibility of MRI-Guided Breast Biopsy of Breast Minimal Lesions in Chinese Population

Recent Progress for the Techniques of MRI-Guided Breast Interventions and their applications on Surgical Strategy

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