Freehand 3T MR-guided vacuum-assisted breast biopsy (VAB): a five-year experience

Abstract

Background Magnetic resonance (MR) permits the detection of some malignant lesions that cannot be identified with mammography or ultrasonography. The characterization of these MR-only detectable lesions often requires a biopsy. Purpose To evaluate the technique, the feasibility and the accuracy of freehand 3T MR-guided VAB for the characterization of suspicious, MR-only detectable lesions and to compare VAB results with surgical pathology and follow-up imaging results. Material and Methods During 2010-2015, 118 women who were referred for MR-guided VAB were retrospectively reviewed. All BI-RADS MR 4 and 5 lesions and some BI-RADS MR 3 lesions (according to clinical context and patient anxiety) were scheduled to undergo biopsy. Results A total of 123 suspicious lesions were retrospectively selected. Technical failures occurred in only two cases (1.6%) due to the location of the lesions. Histopathological results revealed 59 benign lesions (48%), 27 high-risk lesions (22%), and 35 malignant lesions (28.4%). Surgical pathology results led to the reclassification of eight B3 lesions: one proved to be a ductal carcinoma in situ, while seven presented with invasive features. B3 underestimation also occurred in 29% of the cases. MR follow-up was achieved for all the benign lesions and no false-negative cases were observed. No complications, 3T-related artefacts, or difficulties were observed. Conclusion Freehand 3T MR-guided VAB was found to be a valid, safe, fast, and inexpensive alternative to surgical histology.

MR imaging-guided vacuum assisted breast biopsy: Radiological-pathological correlation and underestimation rate in pre-surgical assessment

“…In our study, we reported lower UR than that reported in literature: 10 % of our total cases, compared to 25 % obtained by Verheyden et al [ 55 ] and 23 % by Dratwa et al [ 20 ]. In our series, 38 % of cases were classified as B3 lesions, compared to 50 % observed by Crystal et al [ 54 ] and 29 % by Gristina et al [ 18 ]. These discrepancies are partly justified by the fact that, according to Schrading [ 34 ], we have collected larger amounts of tissue for each procedure, allowing successful sampling, thus improving the diagnostic yield.…”

“…The majority of MRgVABB procedures that have been reported in existing studies were performed with automated guided techniques designated software programs and medical devices [ 17 , 31 ]. A freehand VABB approach has been described in few other studies in the literature [ 18 , 32 , 33 ]. Freehand technique is more accessible and less expensive than automated techniques as it does not require any specifically designed software, hardware and medical devices.…”

“…The reported technical success rates of MR-guided biopsies with automated guided techniques are within the interval of 96–100 %, and the cancer yields are in the interval of 28–38 % [ 17 , 31 ]. Technical success of manual approaches has been reported to be approximately 95 %, with cancer yields of 14–20 % [ 18 , 32 , 33 ].…”

“…Our results appear consistent with prior researches where B3 lesions were often underestimated [ 55 ]. Our study showed that underestimated lesions were significantly associated with the presence of a mass enhancement in MR [ 18 ]. In some studies, B3 lesions that were upgraded to B5 at final pathology represented true-positive results as well [ 21 ].…”

“…Although anesthesia and surgical techniques are aimed to reduce the surgery’s impact on patients(e.g. ERAS protocols) [ [12] , [13] , [14] , [15] , [16] ], several publications demonstrate how MR-guided vacuum-assisted breast biopsy(MRgVABB) is a safe and accurate technique for evaluation of MR-only breast lesions [ 6 , 8 , 10 , 11 , [17] , [18] , [19] , [20] , [21] ]. Nevertheless, there's a lack of evidence proving imaging predictive features of MR-only lesions according to existing literature [ 18 , 21 , 22 ].…”