Sonographic-MRI Correlation After Percutaneous Sampling of Targeted Breast Ultrasound Lesions: Initial Experiences With Limited-Sequence Unenhanced MRI for Postprocedural Clip Localization

Lee, Amie Y.; Nguyen, Vicky T.; Arasu, Vignesh A.; Greenwood, Heather; Ray, Kimberly M.; Joe, Bonnie N.; Price, Elissa R.

doi:10.2214/ajr.17.18489

Cited by 19 publications

(6 citation statements)

References 25 publications

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“…[23][24][25] Using this technique, Lee et al found an additional malignancy in 1 of 10 discordant cases where MRI showed the clip was not at the expected location following ultrasoundguided biopsy. 19 In the current study, marker clips were used when the target lesion was relatively subtle and could be challenging for subsequent pre-operative localisation or there was uncertainty about the verity of a sonographic correlate (Figs 2 and 5).…”

Section: Discussionmentioning

confidence: 94%

“…Use of a limited non‐contrast MRI examination after insertion of a suitable marker clip can be very helpful, particularly when there is pathologic discordance after biopsy of an apparent sonographic correlate 23–25 . Using this technique, Lee et al found an additional malignancy in 1 of 10 discordant cases where MRI showed the clip was not at the expected location following ultrasound‐guided biopsy 19 . In the current study, marker clips were used when the target lesion was relatively subtle and could be challenging for subsequent pre‐operative localisation or there was uncertainty about the verity of a sonographic correlate (Figs 2 and 5).…”

Section: Discussionmentioning

confidence: 99%

“…Anatomical features or co‐existing lesions near to the target can provide useful location markers 16,17 . It is also important to be aware that targeted ultrasound can sometimes erroneously suggest a correlate for the MRI finding, a scenario documented at 13% and 26% in studies by Meissnitzer and Lee, respectively 18,19 …”

Section: Introductionmentioning

confidence: 99%

“…16,17 It is also important to be aware that targeted ultrasound can sometimes erroneously suggest a correlate for the MRI finding, a scenario documented at 13% and 26% in studies by Meissnitzer and Lee, respectively. 18,19 This retrospective study aimed to determine the percentage of MRI-detected breast cancers that could be diagnosed using targeted ultrasound and standard 14gauge (14g) biopsy in the setting of an Australian breast MRI service. This is of importance because malignancies not identifiable on mammography or by ultrasound may then require more invasive, technically demanding and costly MRI-guided interventional procedures.…”

Section: Introductionmentioning

confidence: 99%

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12‐year review of MRI‐detected breast cancers. How often was a diagnosis of malignancy established using targeted ultrasound and standard 14‐gauge core biopsy?

Price¹

2021

J Med Imag Rad Onc

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Introduction: This retrospective study aimed to determine the percentage of MRI-detected breast cancers diagnosed using targeted ultrasound and standard 14-gauge (14g) biopsy in the setting of an Australian breast MRI service. This is of clinical relevance because malignancies not identifiable on mammography or by ultrasound may then require more invasive, technically demanding and costly MRI-guided interventional procedures, usually by largecore vacuum-assisted biopsy (VAB) or hook-wire localisation with open surgical biopsy. Methods: On review of the 12-year period 2006-2018, we identified 67 new breast cancer events in 64 women where the diagnosis was made on the basis of the MRI scan findings either alone (n = 60) or in combination with a concurrent mammogram (n = 7), with no recorded clinical abnormality. The percentage in which malignancy was confirmed on histopathology using targeted ultrasound in combination with 14g biopsy was determined versus other biopsy methods, for both invasive cancer and in situ disease. Results: Ultrasound-guided 14g biopsy was successful in establishing the presence of malignancy in 42/46 (91%) of events with a final diagnosis of invasive cancer, with 2 more proven by MRI-guided interventional procedures (1 VAB and 1 hook-wire) and 1 by open surgical biopsy. In the final case, a 5 mm focus on MRI with no sonographic correlate at the initial presentation was only identified and biopsied by ultrasound at 12-month follow-up.For events with a final diagnosis of DCIS/pLCIS (pleomorphic LCIS, n = 2), US-guided 14g biopsy was successful in 10/21 (48%), while 4/7 events with corresponding mammographic microcalcifications were proven by x-ray stereotactic interventions. A further 5 events had MRI-guided interventions and 1 an open surgical biopsy to confirm malignancy. In the final case (a woman with a 30 9 20 mm focal area of non-mass enhancement with corresponding microcalcifications consistent with DCIS), a pathologic diagnosis was not made until the patient presented 5 years later with invasive disease. There were also 3 instances of upgrades to invasion on final surgical pathology, one from pLCIS to microinvasion and 2 others from DCIS to IDC. Among the DCIS/pLCIS events, semi-random 14g core biopsy (sampling at the expected location of the MRI abnormality without a specific sonographic correlate) proved to be successful in 3 women. Conclusion: Ultrasound-guided 14g core biopsy established a malignant diagnosis in 91% of invasive cancers and in 48% of DCIS/pLCIS cases. This relatively non-invasive, technically easy to perform and low-cost biopsy procedure can be used immediately when targeted ultrasound shows a correlate for a suspicious MRI scan finding. Careful imaging-pathologic correlation is required after 14g biopsy, and a discordant result will usually prompt recourse to an MRI-guided VAB or hook-wire localisation.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

12‐year review of MRI‐detected breast cancers. How often was a diagnosis of malignancy established using targeted ultrasound and standard 14‐gauge core biopsy?

Price¹

2021

J Med Imag Rad Onc

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“…But the presumed correlate depicted on the ultrasound image does not truly represent the lesion noted on MRI [34]. Amie Y. Lee et al [35] found that the presumed sonographic correlate was not the true correlate in 26% of 38 cases and that subsequent MRIguided biopsy of the actual lesion detected on MRI revealed one malignancy in discordant cases. These related researches prove the necessity of the MRIguided intervention.…”

Section: Main Technical Issues Of Mri-guided Detection and Therapeutimentioning

confidence: 99%

Recent Progress for the Techniques of MRI-Guided Breast Interventions and their applications on Surgical Strategy

Gao¹,

Kong²,

Song³

et al. 2020

J. Cancer

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With a high sensitivity of breast lesions, MRI can detect suspicious lesions which are occult in traditional breast examination equipment. However, the lower and variable specificity of MRI makes the MRI-guided intervention, including biopsies and localizations, necessary before surgery, especially for patients who need the treatment of breast-conserving surgery (BCS). MRI techniques and patient preparation should be first carefully considered before the intervention to avoid lengthening the procedure time and compromising targeting accuracy. Doctors and radiologists need to reconfirm the target of the lesion and be very familiar with the process approach and equipment techniques involving the computer-aided diagnosis (CAD) tools and the biopsy system and follow a correct way. The basic steps of MRI-guided biopsy and localization are nearly the same regardless of the vendor or platform, and this article systematically introduces detailed methods and techniques of MRI-guided intervention. The two interventions both face different challenging situations during procedures with solutions given in the article. Post-operative statistics show that the complications of MRI-guided intervention are infrequent and mild, and MRI-guided biopsy provides the pathological information for the subsequent surgical decisions and MRI-guided localization fully prepared for follow-up surgical biopsy. New techniques for MRI-guided intervention are also elaborated in the article, which leads to future development. In a word, MRI-guided intervention is a safe, accurate, and effective technique with a low complication rate and successful MRI-guided intervention is truly teamwork with efforts from patients to surgeons, radiologists, MRI technologists, and nurses.

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MRI-Guided Biopsy Procedures

Seely

2019

Interventional Breast Procedures

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Sonographic-MRI Correlation After Percutaneous Sampling of Targeted Breast Ultrasound Lesions: Initial Experiences With Limited-Sequence Unenhanced MRI for Postprocedural Clip Localization

Cited by 19 publications

References 25 publications

12‐year review of MRI‐detected breast cancers. How often was a diagnosis of malignancy established using targeted ultrasound and standard 14‐gauge core biopsy?

12‐year review of MRI‐detected breast cancers. How often was a diagnosis of malignancy established using targeted ultrasound and standard 14‐gauge core biopsy?

Recent Progress for the Techniques of MRI-Guided Breast Interventions and their applications on Surgical Strategy

MRI-Guided Biopsy Procedures

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