Rationale and Objectives
To determine the cancelation rate of magnetic resonance imaging (MRI)-guided procedures in suspicious breast lesions initially detected at 3.0 Tesla (T) MRI.
Materials and Methods
With institutional review board approval, a Health Insurance Portability and Accountability Act–compliant retrospective review of 117 suspicious 3.0 T MRI-detected lesions in 101 patients scheduled to undergo MRI-guided procedures was performed; informed consent was waived. Patient information, imaging features, and outcome data were collected and compared among completed and canceled procedures using Fisher’s exact test.
Results
MRI-guided breast biopsies were canceled in 13% (15/117) because of lesion nonvisualization, including three (20%) masses, one (1%) focus, and 11 (73%) areas of nonmasslike enhancement. Median lesion size was 1.1 cm. Sixty percent (9/15) of nonvisualized lesions were associated with minimal or mild background parenchymal enhancement at MRI. The nonvisualization rate was not associated with patient age, menopausal status, lesion type, size, breast density, or background parenchymal enhancement ( P > .7 for each). No cancers were detected at original lesion sites in 14 (93%) patients undergoing follow-up imaging ( n = 11) or mastectomy ( n = 3) for cancer elsewhere; one (7%) was lost to follow-up.
Conclusion
The MRI-guided breast biopsy cancelation rate from nonvisualization of suspicious lesions originally detected with 3.0 T MRI scanning was 13%, similar to rates reported for lesions detected at 1.0 and 1.5 T MRI. No cancers were detected on follow-up imaging. Canceling MRI-guided biopsies because of lesion nonvisualization is a reasonable approach if measures are taken to ensure lesion resolution at the time of biopsy and at imaging follow-up.
Contrast-enhanced breast magnetic resonance imaging (MRI) is the most sensitive imaging modality for the detection of breast cancer. Because its superior sensitivity results from high-contrast resolution, suspicious lesions detected by MRI may not be visualized with other imaging modalities such as mammography and ultrasound . Histological sampling of suspicious, MRI-only-detected lesions must be performed using MRI-guided procedures such as MRI-guided vacuum-assisted core needle biopsy (VAB) and MRI-guided needle localization (NL). However, nonvisualization of a previously identified suspicious MRI-detected lesion in the breast on the day of MRI-guided intervention has been reported to occur between 5% and 15% of the time , resulting in procedure cancelation; most of these reports described diagnostic MRI exams performed on lower field strength 1.0 and 1.5 Tesla (T) MRI scanners .
Over the past 5–10 years, higher field strength 3.0 T MRI scanners have been used for cranial, musculoskeletal, and angiographic applications, showing promise for improving spatial resolution, contrast-to-noise ratios, and faster acquisition times . However, there is a paucity of data describing the use of higher field strength MRI for detection of breast lesions and subsequent procedure cancelation because of lesion nonvisualization during MRI-guided breast procedures. A recent study by Brennan et al describing cancelation of MRI-guided breast biopsy because of lesion nonvisualization included diagnostic MRI examinations performed using both 1.5- and 3.0-T scanners, but data pertaining to each magnetic field strength were not reported.
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Materials and methods
Study Population
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MRI Scanning Protocol
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Siemens Trio
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GE Signa
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MRI-guided Procedure Protocol
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Canceled MRI-guided Procedures
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Results
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Patients Characteristics
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Table 1
Patient and Imaging Characteristics
Characteristic Canceled Biopsies ( n = 15, Lesions Not Visualized, %) Successful Biopsies ( n = 98, Lesions Visualized, %) ∗ P Value Patient age .6 ≤49 years 8 (53) 40/86 (47) ≥50 years 7 (47) 46/86 (53) Median 42 51 Range 28–81 30–78 Menopausal status .6 Pre 7/15 (47) 43/84 (51) Post 8/15 (53) 34/84 (40) Unknown N/A 7/84 (8) Indication for breast MRI Screening 6/15 (40) 37/84 (44) Diagnostic 9/15 (60) 47/84 (56) Breast density 1.0 Extremely or heterogeneous 9/15 (60) 56/84 (61) Scattered or fatty 4/15 (27) 30/84 (30) No mammogram available 22/15 (13) 12/84 (10) Background enhancement .8 Minimal or mild 9/15 (60) 56/84 (67) Moderate of marked 6/15 (40) 28/84 (33) Lesion size .4 ≤10 mm 6/15 (40) 29/98 (30) >10 mm 9/15 (60) 69/98 (70) Median 11 19 Range 5–84 3–114 Lesion type 1.0 Mass 3/15 (20) 20/98 (20) NMLE 11/15 (73) 71/98 (72) Focus 1/15 (7) 7/98 (7)
MRI, magnetic resonance imaging; NMLE, nonmasslike enhancement.
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Imaging Characteristics
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Table 2
Morphologic Descriptors of Masses ( n = 23)
Descriptor Number of Masses Visualized ( n = 20) Number of Masses Nonvisualized ( n = 3) Shape Round 8/23 (35) 0/23 (0) Oval 4/23 (17) 1/23 (1) Lobular 1/23 (1) 0/23 (0) Irregular 7/23 (30) 2/23 (9) Margins Smooth 5/23 (22) 0/23 (0) Irregular 12/23 (52) 3/23 (13) Spiculated 3/23 (13) 0/23 (0) All masses 20/23 (87) 3/23 (13)
Data in parentheses are percentages.
Table 3
Morphologic Descriptors of NMLE ( n = 86)
Descriptor Number of NMLE Visualized ( n = 75) Number of NMLE Nonvisualized ( n = 11) Focal 25/86 (29) 4/86 (5) Linear/ductal 30/86 (35) 5/86 (6) Segmental 7/86 (8) 1/86 (1) Regional 11/86 (13) 1/86 (1) Diffuse 2/86 (2) 0/86 (0) All NMLE 75/86 (9) 11/86 (13)
NMLE, nonmasslike enhancement.
Data in parentheses are percentages.
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Imaging and Histologic Follow-up
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Discussion
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