New preoperative MRI marking technique for a patient with ductal carcinoma in situ

Abstract

We herein present a case of non-palpable ductal carcinoma in situ (DCIS) treated with successful breast-conserving surgery (BCS) using MR markers made with commercially available materials in the supine position. The patient was a 40-year-old woman found to have a non-mass lesion by routine screening ultrasonography (US). The margin of the lesion was unclear by the US examination, whereas contrast-enhanced MR mammography (MRM) revealed a clear margin of the lesion. After the resection line was determined by under US guidance, the area was marked by original markers for MRI using the pills of Breath Care inside a Penrose drain. MRM was performed in the supine position (supine MRM), which is similar to the posture used for surgery. The lesion was located within the resection area, but it was not at the center of the resection area; thus, the resection lines were modified using information obtained by MRM. The histological evaluation of the BCS specimen demonstrated a wide extension of the DCIS. The lesion was located at the center of the resection specimen, and the surgical margin was free. In conclusion, since our procedure can be performed easily, it is useful for evaluating the extent of the lesion as determined by the US examination in difficult cases.

Preoperative MRI marking technique for the planning of breast-conserving surgery

“…The pills Fig. 1 Flowchart of the whole steps from diagnosis to surgery of Breath Care Ò (Kobayashi Pharmaceutical Co. Ltd., Osaka, Japan) used as MRI markers were placed in the Penrose drain with 2-cm intervals, and drains were put on the resection lines as determined by the US examination [12].…”

“…Tozaki and Fukuda reported the usefulness of MRI in the supine position (supine MRI) using the parallel acquisition technique for planning BCS [11]. In addition, we reported a case of non-palpable ductal carcinoma in situ (DCIS) treated with a successful BCS using a new preoperative MRI marking technique in the supine position [12]. The aim of this study was to evaluate the accuracy of this MRI marking technique for planning BCS.…”

Breast Imaging and Volume Navigation: MR imaging and Ultrasound Coregistration

“…Some studies have already pointed out the practical advantages of supine MR imaging as a guide for accurate breast-conserving surgery. 29,30 Anatomic landmarks and real-time guidance are both important when performing free-hand core biopsies. It is also easier for the radiologist to perform the biopsy in a standard setting; it is not so friendly to biopsy with the patient supine even with a dedicated guidance system.…”