Interventional MRI of the breast: lesion localisation and biopsy

Abstract

With the growing use of breast MRI an increasing need exists for reliable MR-guided preoperative localisation or even MR-guided needle biopsy. In this article an overview is given of the different approaches and the present state of the art. With closed magnets the following approaches have been made: freehand localisation (similar to CT-guided freehand localisation), and freehand localisation combined with a frameless stereotaxic system operating with support by ultrasound. One localisation device for supine localisation and a thermoplastic mesh for breast stabilisation have been reported. Most investigators have used compression devices to immobilize the breast and prevent shift during needle insertion. Thus far, one immobilisation and aiming device has been designed for open magnets. A small number of experiences exist with interventions on open MR units using a navigation system. Wire localisations are presently a well-established procedure. Magnetic-resonance-guided needle biopsy has been accomplished in closed systems as well as by the use of breast immobilisation devices. However, problems still exist due to severe needle artefacts, tissue shift during the intervention and fast equalization of contrast enhancement in lesions with surrounding tissue. Therefore, needle biopsy is not recommended for lesions < 10 mm. Magnetic-resonance-guided vacuum biopsy is somewhat more invasive but promises to solve most of these problems.

Multicenter Comparative Multimodality Surveillance of Women at Genetic-Familial High Risk for Breast Cancer (HIBCRIT Study): Interim Results

“…As reported in a recent review (15), researchers determined that contrast material-enhanced magnetic resonance (MR) imaging is highly sensitive for identification of breast cancer in a large spectrum of clinical situations. Because of lower values for specificity and positive predictive value (PPV), with contrast-enhanced MR imaging, however, unnecessary breast biopsy has been reported because of false-positive findings (16,17), especially in premenopausal women (18,19) and also in high-risk women (20).…”

Wireless Accelerometer for MRI-Guided Interventional Procedures

“…Without automatic slice selection of scan planes, passive techniques require manual slice calculation and repositioning which add time to interventional procedures. However, this simpler approach has been widely adopted in clinical settings, in particular for MRI-guided breast biopsy [1,[11][12][13]. In contrast, active tracking gives the operator direct instrument control with immediate feedback under real-time MR image guidance.…”

“…In particular, MRI guidance has been adopted for minimally-invasive procedures such as biopsy and tissue ablation in breast, prostate, orthopaedic and vascular applications [1][2][3][4][5]. A number of specialist interventional MR scanners, often with open configuration, have been employed effectively for minimally-invasive procedures [6,7].…”

MR‐guided breast biopsy using an active marker: A phantom study

“…In general, lesions smaller than 10 mm in diameter are considered very small (5). There are only a few other phantom studies on MR-guided breast biopsy (9,17) known to the authors that offer quantitative data on the targeting accuracy.…”

“…However, positive predictive value is only moderate to low; i.e., approximately 30% to 75% of MR-detected lesions turn out to be benign (2,5,6). Thus, histological verification for MR-detected breast lesions is required.…”