Underestimation Rate at MR Imaging–guided Vacuum-assisted Breast Biopsy: A Multi-Institutional Retrospective Study of 1509 Breast Biopsies

Verheyden, Cécile; Pages-Bouic, Emma; Balleyguier, Corinne; Chérel, P.; Lepori, D.; Laffargue, G.; Doutriaux, Isabelle; Jalaguier, Aurélie; Poncelet, E.; Millet, Ingrid; Thomassin‐Naggara, Isabelle; Taourel, Patrice

doi:10.1148/radiol.2016151947

Cited by 33 publications

(24 citation statements)

References 40 publications

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“…Here, our study yields some interesting results: mass lesions seem to have a significantly higher malignancy rate than non-mass lesions (31% compared to 0%). This is in accordance with a large retrospective multi-institutional study showing that upgrades of ADH and DCIS diagnosed at MR-guided VAB are significantly associated with the presence of a mass on MR imaging [ 25 ]. Furthermore, our study indicates a higher malignant potential for smaller lesions ≤10 mm (PPV 35%) compared to lesions measuring 11–20 mm (PPV 23%) in case of MR-only lesions.…”

Section: Discussionsupporting

confidence: 91%

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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Section: Discussionsupporting

confidence: 91%

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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“…According to our experience, a multidisciplinary approach concerning the clinical risks of these cases should be provided. In this study, high-risk benign lesions were 19% of all lesions, concordant with the relevant literature (4%-21.5%) (19)(20)(21)(22)(23)(24)(25). Underestimation rate for high-risk benign lesions in this study was 21.4% (3/14), which was also similar with recent studies (19)(20)(21)(22)(23)(24)(25).…”

Section: Discussionsupporting

confidence: 92%

“…Heller et al (21) reported that upgrade rates of high-risk lesions were significantly higher in cases with a history of malignant lesion in the same breast, recently diagnosed cancer, or history of high-risk lesion. No statistically significant relationship between lesion type or size and the underestimation rates was found in the literature ( 11,(19)(20)(21)(22)(23)(24)(25). Surgical excision is mandatory for high-risk lesions found at MRI-guided VABB, similar to other imaging-guided biopsy procedures.…”

Section: Discussionmentioning

confidence: 96%

Lesion characteristics, histopathologic results, and follow-up of breast lesions after MRI-guided biopsy

Taşkın

Soyder²,

Tanyeri³

et al. 2017

Diagn Interv Radiol

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M agnetic resonance imaging (MRI) is a widely used diagnostic tool for breast imaging in daily practice, with its high sensitivity to detect primary, recurrent, and residual breast cancer. Breast MRI serves as a reliable problem-solving tool in case of inconclusive mammography and ultrasonography (US) findings. It can be used to monitor the results of neoadjuvant chemotherapy and it may also contribute to preoperative evaluation of known lesions. With increasing use of MRI, number of breast lesions visible only on MRI and need for MRI-guided breast biopsy have increased (1). Second-look US can also be used for re-evaluation of these lesions; because US-guided biopsy is an easier, cheaper, and faster method if these lesions are visible on second-look US. According to a recently published meta-analysis, lesion detection rates with second-look US are variable in the literature (22.6%-82.1%). Mass lesions and malignant lesions were more likely to be detected at second-look US; average detection rates were 66% for masses, 29% for non-mass-like enhancement (NME) (2, 3). However, focal or NME lesions, which are less detectable than masses on second-look US, require MRI-guided biopsy in the majority of cases. According to the MRI-guided biopsy series in the literature, approximately 25%-35% of these lesions are diagnosed as malignant (4-9).Within this context, the aim of the present study is to assess the effectiveness of MRI-guided 10 Gauge (G) vacuum-assisted breast biopsies (VABB) performed at our institution and to examine the relationship between lesion characteristics and histopathologic results. B R E A S T I MAG I N G O R I G I N A L A R T I C L E PURPOSEWe aimed to assess the effectiveness of magnetic resonance imaging (MRI)-guided vacuum-assisted breast biopsy (VABB), evaluate and compare the characteristics and histopathologic findings of lesions, and overview the follow-up results of benign lesions. METHODSMRI findings and histopathologic results of breast lesions biopsied by MRI-guided VABB between 2013 and 2016 were retrospectively analyzed. MRI findings closely related with malignancy were investigated in particular. Follow-up results of benign lesions were evaluated. RESULTSMRI-guided VABB was applied to 116 lesions of 112 women. Of the lesions, 75 (65%) were benign, while 41 (35%) were malignant. Segmental (94%), clustered (89%), and clustered ring (67%) nonmass-like enhancement patterns were found to be more related with malignancy. False-negative rate of MRI-guided VABB was 12%, underestimation rate was 21%. One of the 54 followed-up benign lesions had a malignant result. CONCLUSION MRI-guided VABB is a reliable method for the diagnosis of breast lesions that are positive only on MRI. Follow-up results show that cancer detection rate is low for radio-pathologically concordant lesions. Further multicenter studies with larger patient population are needed to elucidate these results.You may cite this article as: Taşkın F, Soyder A, Tanyeri A, Öztürk VS, Ünsal A. Lesion characteristics, histopathologic r...

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“…For nearly 100% of respondents in Québec and France, the estimated performed number of weekly MRI-guided biopsies was reported as 5 or less, which may at first glance appear quite low. However, these numbers are in agreement with a recent multi-centric retrospective French and Swiss study reviewing 1709 MRI-guided biopsies collected over a 7-year period in nine institutions, representing an average number of 27 biopsies per year, per institution [19].…”

Section: Mri-guided Biopsies (Questions 5 and 6)supporting

confidence: 88%

Utilization of breast MRI and breast MRI-guided biopsy in clinical practice: results of a survey in Québec and France

2020

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Background: To investigate the practice regarding breast MRI exams and breast MRI-guided biopsies in two countries with different health care systems, France and Québec. A 12-item questionnaire was distributed online among radiologists from France and Québec, attempting to determine: demographic characteristics and breast MRI diagnostic and MRI-guided practices (indications, workload, availability, and waiting time assessment). Results: One hundred and seventy radiologists (France, 132 respondents (28.5%); Quebec, 38 respondents (35.2%)) participated in the survey, most of them based in non-academic centers. Thirty-eight percent of Quebec and 2.3% of French radiologists did not perform breast MRI in their daily practice. Nearly 50% of French and Quebec respondents interpreted 1-10 breast MRI exams per week. Decision-making factors of preoperative MRI were similar in both countries (pathology, age, and breast density), with a heavier emphasis placed on the surgeon's opinion in Quebec (47.8% versus 21.8% (p = 0.009)). Quebec demonstrated a higher waiting time than France (1-2 weeks in 40% versus less than 1 week in 40%). MRI-guided breast biopsies (less than 5 MRI-guided biopsies per week) were being performed by a minority of the respondents (36% in France and 43% in Québec). Conclusion: Most of radiologists performing breast MRIs work in non-academic institutions in both countries. Waiting time is higher in Quebec, but most of preoperative breast MRIs are performed within 3 weeks in both countries. The surgeon plays an important role in recommending preoperative MRI in Quebec. MRI-guided breast biopsies are not widely available in both countries.

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Underestimation Rate at MR Imaging–guided Vacuum-assisted Breast Biopsy: A Multi-Institutional Retrospective Study of 1509 Breast Biopsies

Cited by 33 publications

References 40 publications

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

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

Lesion characteristics, histopathologic results, and follow-up of breast lesions after MRI-guided biopsy

Utilization of breast MRI and breast MRI-guided biopsy in clinical practice: results of a survey in Québec and France

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