Magnetic Resonance Imaging–Guided Vacuum-Assisted Breast Biopsy: An Initial Experience in a Community Hospital

Abstract

This study demonstrated that detection of cancerous and high-risk lesions can be significantly increased when an MRI-guided biopsy program is introduced at a community-based hospital. We believe that as radiologists gain confidence in imaging and histologic correlation, community-based hospitals can achieve similar rates of occult lesion diagnosis as those found in data emerging from academic institutions.

High-risk lesions diagnosed at MRI-guided vacuum-assisted breast biopsy: can underestimation be predicted?

“…Both frequency of high-risk lesions at MRgVABB and underestimation rates in our study are higher than previously reported in other studies (Table 4) evaluating outcomes of MR-guided breast biopsy [11,12,29,31,32]. This might be explained by the high pretest probability for breast cancer in our study population, which in addition to asymptomatic women undergoing screening MRI included a substantial proportion of diagnostic cases and patients with a personal history of breast carcinoma.…”

“…Moreover, MRI of the breast is superior not only for diagnosis of invasive carcinoma but also for detection of ductal carcinoma in situ (DCIS) and even premalignant breast lesions [4,5]. MRI-guided vacuumassisted breast biopsy (MRgVABB) is a safe and accurate technique for evaluation of otherwise occult MRI-detected breast lesions [6][7][8][9][10][11][12]. However, a considerable proportion of lesions diagnosed on percutaneous breast biopsies are classified as high-risk lesions [13].…”

“…The management of high-risk lesions diagnosed on stereotactic or ultrasound-guided VABB has been very well researched [23][24][25][26][27][28] and surgical excision is usually recommended. There are scanty data regarding underestimation rate at MRgVABB and management of high-risk lesions diagnosed at MRgVABB [11,12,29].…”

Additional findings at preoperative MRI: a simple golden rule for a complex problem?

“…This approach resulted in a rate of change of surgical planning inferior to 10%, composed of mastectomy for lesions [24], many recent single-center experiences [25][26][27][28][29][30][31], also evaluating problems and limitations [32][33][34][35], as well as the results of a multidisciplinary consensus meeting on the use of vacuum-assisted MR-guided biopsy [36]. The mean time needed for an MR-guided procedure is not different than that of a stereotactic biopsy in the film-screen era: about 45 minutes [37].…”