Contrast enhanced spectral mammography (CESM) guided breast biopsy as an alternative to MRI guided biopsy

2022 ◽  
Author(s):  
Jonathan James
Keyword(s):  
Breast Biopsy ◽  
Lobular Carcinoma ◽  
Breast Mri ◽  
Diagnostic Study ◽  
Guided Biopsy ◽  
Iodinated Contrast ◽  
Contrast Enhanced ◽  
Multifocal Breast Cancer ◽  
Conventional Mammography ◽  
Mri Guided

Objective: Contrast Enhanced Spectral Mammography (CESM) breast biopsy has been recently introduced into clinical practice. This short communication describes the technique and potential as an alternative to MRI guided biopsy. Methods and materials: An additional abnormality was detected on a breast MRI examination in a patient with lobular carcinoma. The lesion was occult on conventional mammography, tomosynthesis and ultrasound and required histological diagnosis. Traditionally this would have necessitated a MRI guided breast biopsy, but was performed under CESM guidance. Results: A diagnostic CESM study was performed to ensure the lesion visibility with CESM and then targeted under CESM guidance. A limited diagnostic study, CESM scout and paired images for stereotactic targeting were obtained within a 10 min window following a single injection of iodinated contrast agent. The time from positioning in the biopsy device to releasing compression after biopsy and marker clip placement was 15 min. The biopsy confirmed the presence of multifocal breast cancer. Conclusion: CESM guided breast biopsy is a new technique that can be successfully used as an alternative to MRI guided breast biopsy. Advances in knowledge: CESM guided biopsy can be used to sample breast lesions which remain occult on standard mammography and ultrasound.

First experience with MRI-guided vacuum aspirated breast biopsy

2020 ◽  
pp. 25-31
Author(s):  
M. L. Mazo ◽  
O. E. Jacobs ◽  
O. S. Puchkova ◽  
M. V. Feldsherov ◽  
E. V. Kondratyev
Keyword(s):  
Breast Cancer ◽  
Breast Augmentation ◽  
Breast Biopsy ◽  
Breast Mri ◽  
Breast Tumors ◽  
High Tech ◽  
X Ray ◽  
Vacuum Aspiration ◽  
Mri Guided ◽  
Aesthetic Breast

The rate of detection of breast cancer by MRI, while other methods of radiological diagnosis are not sufficiently informative, ranges from 5.2 to 26.3 per cent. Suspicious breast tumors of category BI-RADS 4, 5 show morphological image-guided biopsy verification, in particular MRI with contrast. Purpose. To show the possibilities and features of carrying out MRI-guided vacuum breast biopsy, including after aesthetic breast augmentation. Material and methods. A comprehensive X-ray, ultrasound and MRI examination of 54 women aged between 28 and 70 years with different breast tumors was conducted. Of these, five were detected only by breast MRI with contrast, and were morphologically verified by MRI-guided vacuum aspiration biopsy. Results. 14 of the 54 patients with breast mass were diagnosed with breast cancer and 26 were diagnosed with benign diseases. The effectiveness of comprehensive examination and low-invasive high-tech MRI-guided procedures in early refined screening for breast cancer, including after aesthetic breast augmentation, has been demonstrated. MRI-guided vacuum-assisted breast biopsy is a fast, safe and accurate diagnostic method of morphological verification of suspicious breast tumors that do not have X-ray and ultrasound.

The Positive Outcome of MRI-Guided Vacuum Assisted Core Needle Breast Biopsies is not Influenced by a Prior Negative Targeted Second-Look Ultrasound

2017 ◽  
Vol 68 (4) ◽  
pp. 401-408 ◽  
Author(s):  
Romuald Ferré ◽  
Shaza AlSharif ◽  
Ann Aldis ◽  
Benoît Mesurolle
Keyword(s):  
High Risk ◽  
Magnetic Resonance ◽  
Breast Mri ◽  
Positive Outcome ◽  
Synchronous Carcinoma ◽  
Second Look ◽  
Guided Biopsy ◽  
Imaging Characteristics ◽  
Mri Features ◽  
Mri Guided

Purpose The study sought to investigate the outcome of breast magnetic resonance–guided biopsies as a function of the indication for magnetic resonance imaging (MRI), the MRI features of the lesions, and the performance or not of a targeted second-look ultrasound (SLUS) prior breast MRI-guided biopsy. Methods We identified 158 women with MRI-detected breast lesions scheduled for MRI-guided biopsy (2007-2013). Patient demographics, performance of targeted SLUS, imaging characteristics, and subsequent pathology results were reviewed. Results Three biopsies were deferred, and 155 lesions were biopsied under MRI guidance (155 women; median age 55.14 years; range 27-80 years). Ninety-eight women underwent a SLUS prior to the MRI-guided biopsy (63%). Of the 155 biopsied lesions, 23 (15%) were malignant, 106 (68%) were benign, and 26 (17%) were high risk. Four of 15 surgically excised high-risk lesions were upgraded to malignancy (27%). Most of the biopsied lesions corresponded to non–mass-like enhancement (81%, 126 of 155) and most of the biopsies (52%, 81 of 155) were performed in a screening context. No demographic or MRI features were associated with malignancy. No differences were noted between the 2 subgroups (prior SLUS vs no prior SLUS) except for the presence of a synchronous carcinoma associated with a likelihood of targeted SLUS before MRI-guided biopsy ( P = .001). Conclusion A negative SLUS does not influence the pathology outcome of a suspicious lesion biopsied under MR guidance.

Compliance with Short-Interval Follow-up MRI after Benign Concordant MRI-guided Breast Biopsy

2020 ◽  
Author(s):  
Shruthi Ram ◽  
Helaina Regen-Tuero ◽  
Grayson L Baird ◽  
Ana P Lourenco
Keyword(s):  
Breast Biopsy ◽  
Short Interval ◽  
False Negative ◽  
False Negative Rate ◽  
Negative Rate ◽  
Guided Biopsy ◽  
Institutional Review ◽  
Biopsy Report ◽  
Mri Guided

Abstract Objective To evaluate compliance with short-interval follow-up MRI after benign concordant MRI-guided breast biopsy. Methods This institutional review board-approved retrospective study included all benign concordant MRI-guided biopsies performed between January 1, 2010, and May 1, 2018. The following was collected from the electronic medical record: patient and lesion characteristics, short-interval follow-up MRI recommendation, communication to referring physician, follow-up imaging, repeat biopsies, biopsy outcome, and patient insurance status. Compliance with recommendations was defined as follow-up MRI within 9 months of biopsy. Results Among 98 patients, there were 107 lesions with benign concordant MRI-guided biopsy results that met study criteria. After excluding 7 patients who underwent subsequent mastectomy, 50/91 (54.9%) patients were recommended short-interval follow-up MRI. Of these, 33/50 (66.0%) had a short-interval follow-up MRI. Direct communication of the short-interval follow-up recommendation was documented in the biopsy report for 4/50 (8%) patients. Subsequent MRI was available for 77/107 (72%) lesions at a median of 29 months following MRI-guided biopsy (range, 3–96 months). Subsequent mammography was available for 21/30 (70%) remaining lesions at a median of 47 months following MRI-guided biopsy (range, 23–88 months). There were two repeat biopsies, with one subsequent malignancy, resulting in a false-negative rate of 0.9% (1/107). Conclusions When short-interval follow-up MRI was recommended following benign concordant MRI-guided breast biopsy, compliance was 66.0%. Lack of communication of the recommendation may at least partially explain the low compliance. The low false-negative rate (0.9%) suggests routine short-interval follow-up MRI may be unnecessary following benign concordant MRI-guided biopsy.

scholarly journals Pure Fibrocystic Change Diagnosed at MRI-guided Vacuum-assisted Breast Biopsy: Imaging Features and Follow-up Outcomes

2020 ◽  
Vol 2 (2) ◽  
pp. 141-146
Author(s):  
Shu-Tian Chen ◽  
Satoko Okamoto ◽  
Bruce L Daniel ◽  
James Covelli ◽  
Wendy B DeMartini ◽  
...  
Keyword(s):  
Breast Biopsy ◽  
Breast Mri ◽  
Lesion Size ◽  
Imaging Features ◽  
Mri Features ◽  
Fibrocystic Change ◽  
Mri Guided ◽  
Lesion Regression ◽  
Mri Characteristics

Abstract Objective Fibrocystic change (FCC) is considered one of the most common benign findings in the breast and may be commonly seen on breast MRI. We performed this study to identify MRI characteristics of pure FCC on MRI-guided vacuum-assisted breast biopsy (VABB) without other associated pathologies and describe the findings on MRI follow-up and outcomes. Methods A retrospective review was performed for 598 lesions undergoing 9-gauge MRI-guided VABB at our institution from January 2015 to April 2018, identifying 49 pure FCC lesions in 43 patients. The associations between variables and lesion changes on follow-up MRI were analyzed using exact Mann-Whitney tests and Fisher’s exact tests. Results MRI features of pure FCC are predominantly clumped nonmass enhancement (19/49, 39%) or irregular masses with initial fast/late washout kinetics (9/49, 18%). There was no upgrade to high-risk or cancerous lesions among the 11 patients (25.6%) who underwent surgery. There were 22 pure FCC lesions in 19 (44.2%) patients who had follow-up MRI (mean 18.0 months, range 11–41 months) showing regression (13, 59%), stability (8, 36%), or progression (1, 5%) of the lesion size, and no cancers were found on follow-up at the site of the MRI biopsy for fibrocystic changes. No patient demographics or lesion features were associated with lesion regression or stability (P > 0.05). Conclusion Our study shows that MRI features of VABB-proven FCC lesions may mimic malignancy. After VABB of pure FCC, given that adequate sampling has been performed, a 12-month follow-up MRI may be reasonable.

MRI-Guided Core Biopsy

2018 ◽  
Author(s):  
Lisa A. Mullen
Keyword(s):  
Core Biopsy ◽  
Breast Biopsy ◽  
Breast Mri ◽  
Key Points ◽  
Mri Guided ◽  
Magnetic Resonance Imaging Mri ◽  
Extent Of Disease ◽  
Mass Enhancement ◽  
High Risk Screening

MRI-guided breast biopsy techniques were developed to sample indeterminate and suspicious breast lesions visible only on MRI. Breast MRI performed for high-risk screening, problem solving, or assessment of extent of disease in patients with newly diagnosed breast cancer may demonstrate indeterminate findings, such as enhancing foci, masses or non-mass enhancement. If the lesion is not visible by mammography or ultrasound, and MRI follow-up is not appropriate, then MRI-guided biopsy is indicated. This chapter, appearing in the section on interventions and surgical changes, reviews the key points and procedural protocols and pitfalls for performance of magnetic resonance imaging (MRI)–guided breast core biopsy. Pre-, peri-, and post-procedure clinical management, radiology–pathology correlation, and imaging follow-up are also reviewed.

scholarly journals MRI-Guided Breast Biopsy-Histopathological Verification of Suspicious Breast Lesions Visible on MRI Only

2020 ◽  
Vol 7 (3) ◽  
Author(s):  
Heinze S ◽  
◽  
Rudnicki W ◽  
Popiela T ◽  
Luczynska E ◽  
...  
Keyword(s):  
Breast Biopsy ◽  
Histopathological Examination ◽  
Kinetic Curve ◽  
Breast Mri ◽  
Breast Lesions ◽  
Benign Lesions ◽  
Biopsy Site ◽  
Histopathology Result ◽  
Mri Guided ◽  
Suspicious Lesions

Background: Breast cancer is currently the most frequently diagnosed cancer in women. While the range of modalities enabling suspicious lesions detection is wide, MRI remains the most sensitive one. Therefore, the number of methods verifying the lesions seen only on MRI images grows. The aim of this study is to check the usefulness of MRI guided breast biopsy in clinical use. Methods: The study involved 120 patients who underwent diagnostic MRI before the biopsy that revealed suspicious lesions (BI-RADS 4 and 5). Those lesions had not been seen on initial ultrasonography or mammography. In each case, a marker was placed in the biopsy site and histopathological examination of the obtained samples was performed. Results: The study revealed benign lesions in 86 patients (71.7%). The remaining 34 lesions (28.3%) were determined as malignant, including 19 noninfiltrating (15.8%) and 15 infiltrating lesions (12.5%). Study showed correlation between kinetic curve type and lesion malignancy. Breast type, BPE and enhancement type did not have impact on the histopathology result. Conclusion: Breast MRI-guided biopsy is a reliable way to verify lesions not visible on any other diagnostic imaging methods and therefore should be developed.

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

2009 ◽  
Vol 60 (4) ◽  
pp. 196-200 ◽  
Author(s):  
Paul Friedman ◽  
Sean Enis ◽  
Jeremy Pinyard
Keyword(s):  
Magnetic Resonance Imaging ◽  
High Risk ◽  
Magnetic Resonance ◽  
Breast Biopsy ◽  
Resonance Imaging ◽  
Community Based ◽  
Guided Biopsy ◽  
Ductal Hyperplasia ◽  
Mri Guided

Objective To evaluate the effectiveness in diagnosing mammographically and sonographically occult breast lesions by using magnetic resonance imaging (MRI) guided vacuum-assisted breast biopsy in patients who presented to a community-based hospital with a newly established breast MRI program. Methods The records of 142 consecutive patients, median age of 55 years, who had undergone MRI-guided biopsy at our institution between July 2006 and July 2007 were reviewed. From these patients, 197 mammographically and sonographically occult lesions were biopsied at the time of discovery. The pathology was then reviewed and correlated with the MRI findings. Results Cancer was present and subsequently discovered in 8% of the previously occult lesions (16/197) or 11% of the women studied (16/142). Of the cancerous lesions, 56% were invasive carcinomas (9/16) and 44% were ductal carcinomas in situ (7/16). Fourteen percent of the discovered lesions (28/197) were defined as high risk and included atypical ductal hyperplasia, atypical lobular hyperplasia, lobular carcinoma in situ, and radial scar. In total, occult cancerous and high-risk lesions were discovered in 22% of the found lesions (44/197) or 31% of the women who underwent MRI-guided biopsy (44/142). Conclusions 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.

scholarly journals Axillary Nodal Metastases from Carcinoma of Unknown Primary (CUPAx): Role of Contrast-Enhanced Spectral Mammography (CESM) in Detecting Occult Breast Cancer

2021 ◽  
Vol 11 (6) ◽  
pp. 465
Author(s):  
Melania Costantini ◽  
Rino Aldo Montella ◽  
Maria Paola Fadda ◽  
Giorgia Garganese ◽  
Alba Di Leone ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Breast Imaging ◽  
Breast Biopsy ◽  
Unknown Primary ◽  
Axillary Lymph ◽  
Axillary Lymph Node Metastases ◽  
Occult Breast Cancer ◽  
Guided Biopsy ◽  
Contrast Enhanced

Axillary lymph node metastases of occult breast cancer (CUPAx) is an unusual condition that represents both a diagnostic and therapeutic challenge. The first steps in the diagnostic work-up of patients with CUPAx are the histological analysis of the lymph node metastasis and the execution of basic breast diagnostic imaging (mammography and ultrasound). In the case of occult breast cancer, breast Magnetic Resonance (MR) must be performed. Breast MR identifies a suspicious lesion in many patients and second-look ultrasound detects a corresponding ultrasound alteration in about half of cases, allowing the performance of a US-guided biopsy. In the case of an MR-only lesion, MR-guided biopsy is mandatory. We present a case of CUPAx in which contrast-enhanced spectral mammography (CESM) is used to help the detection of occult breast cancer and to guide stereotactic vacuum breast biopsy (VABB). CESM is a new breast imaging technique that is proving to have good performance in breast cancer detection and that is showing potential in the identification of occult breast cancer in a CUPAx setting. The use of an innovative and personalized breast imaging approach in breast cancer patients improves diagnostic possibilities and promises to become the focus in decision strategies.

Contrast-enhanced Mammography: A Guide to Setting Up a New Clinical Program

2021 ◽  
Author(s):  
Geunwon Kim ◽  
Bhavika Patel ◽  
Tejas S Mehta ◽  
Linda Du ◽  
Rashmi J Mehta ◽  
...  
Keyword(s):  
Contrast Material ◽  
Breast Mri ◽  
Alternative Form ◽  
Successful Implementation ◽  
Clinical Workflow ◽  
Iodinated Contrast ◽  
Contrast Enhanced ◽  
Clinical Program ◽  
Uptake Studies ◽  
Staffing Requirements

Abstract Contrast-enhanced mammography (CEM) is gaining rapid traction following the U.S. Food and Drug Administration approval for diagnostic indications. Contrast-enhanced mammography is an alternative form of mammography that uses a dual-energy technique for image acquisition after the intravenous administration of iodinated contrast material. The resulting exam includes a dual set of images, one that appears similar to a routine 2D mammogram and one that highlights areas of contrast uptake. Studies have shown improved sensitivity compared to mammography and similar performance to contrast-enhanced breast MRI. As radiology groups incorporate CEM into clinical practice they must first select the indications for which CEM will be used. Many practices initially use CEM as an MRI alternative or in cases recommended for biopsy. Practices should then define the CEM clinical workflow and patient selection to include ordering, scheduling, contrast safety screening, and managing imaging on the day of the exam. The main equipment requirements for performing CEM include CEM-capable mammography equipment, a power injector for contrast administration, and imaging-viewing capability. The main staffing requirements include personnel to place the intravenous line, perform the CEM exam, and interpret the CEM. To safely and appropriately perform CEM, staff must be trained in their respective roles and to manage potential contrast-related events. Lastly, informing referring colleagues and patients of CEM through marketing campaigns is helpful for successful implementation.

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