MRI-Guided Intervention for Breast Lesions Using the Freehand Technique in a 3.0-T Closed-Bore MRI Scanner: Feasibility and Initial Results

OBJECTIVE: To report the feasibility of magnetic resonance imaging (MRI)-guided intervention for diagnosing suspicious breast lesions detectable by MRI only, using the freehand technique with a 3.0-T closed-bore MRI scanner. MATERIALS AND METHODS: Five women with 5 consecutive MRI-only breast lesions underwent MRI-guided intervention: 3 underwent MRI-guided needle localization and 2, MRI-guided vacuum-assisted biopsy. The interventions were performed in a 3.0-T closed-bore MRI system using a dedicated phased-array breast coil with the patients in the prone position; the freehand technique was used. Technical success and histopathologic outcome were analyzed. RESULTS: MRI showed that four lesions were masses (mean size, 11.5 mm; range, 7-18 mm); and 1, a nonmass-like enhancement (maximum diameter, 21 mm). The locations of the lesions with respect to the breast with index cancer were as follows: different quadrant, same breast - 3 cases; same quadrant, same breast - 1 case; and contralateral breast - 1 case. Histopathologic evaluation of the lesions treated with needle localization disclosed perilobular hemangioma, fibrocystic change, and fibroadenomatous change. The lesions treated with vacuum-assisted biopsy demonstrated a radial scar and atypical apocrine hyperplasia. Follow-up MRI after 2-7 months (mean, 4.6 months) confirmed complete lesion removal in all cases. CONCLUSION: MRI-guided intervention for breast lesions using the freehand technique with a 3.0-T closed-bore MRI scanner is feasible and accurate for diagnosing MRI-only lesions.

Agulhamento por ressonância magnética - descrição da técnica / Magnetic resonance guided needle localization - technique description

A ressonância magnética mamária apresenta ótima sensibilidade para o diagnóstico do câncer de mama, detectando cânceres insuspeitos à mamografia, à ultra-sonografia e à palpação. É fundamental que se tenha acesso às lesões diagnosticadas apenas por esse método. Um exame ultra-sonografico dirigido à área da lesão da ressonância magnética só encontra a lesão em cerca de 23% dos casos. Os demais devem ser abordados com orientção pela ressonância magnética. A localização das lesões pela ressonância magnética é rotineira em alguns centros, mas ainda não é amplamente disponível no Brasil. Esse trabalho descreve uma técnica de localização pré-operatória (agulhamento) de lesões mamárias orientada pela ressonância magnética, com o objetivo de tornar essa técnica mais conhecida na comunidade da mastologia.

Magnetic resonance imaging of the breast has excellent sensibility, and is able to detect breast cancers that cannot be detected by mammography, ultrasound or physical examination. It is required, though, that detected lesions can be accessed for biopsy. Second-look sonography fails to demonstrate the lesion in up to 77% of the patients. The remainders will need a magnetic resonance guided procedure. These procedures are routinely performed in many centers, but still not widely available in our country. This paper describes the technique for magnetic resonance guided needle localization of breast lesions, with the purpose of making those involved with breast health care more familiar with it.

A look at utilization and cancer detection yield of mammography

BACKGROUND: In the Philippines, mammography is frequently requested in the evaluation of patients with breast cancer concern. OBJECTIVES: The general objective was to take a look at the practice of requesting for a mammography in a health care institution and its outcome in terms of cancer detection in patients with non- palpable breast masses. METHODS: A retrospective review of past records from 1994 to 2001 was accomplished. RESULTS: A total of 7,323 mammog-raphies. 192 (3 percent) were done in the 20-29 age group; 966 (13 percent) in 30-39 age group; 2708 (37 percent) in 40-49 age group, 2410 (33 percent) in 50-59 age group and the remaining 1047 (14 percent) in those older than 60 years old. The top three physicians requesting for mammography were obstetrician-gynecologists, 2337 (32 percent); general surgeons, 1348 (18 percent) and internists and family medicine specialists, 806 (10 percent). Normal findings were reported in 4449 (61 percent); benign in 2721 (37 percent), suspicious for cancer without a clinically palpable mass in 99 (1.35 percent) and suspicious for cancer with a palpable breast mass in 52 patients (0.74 percent). A total of 50 patients underwent needle localization biopsy of which 35 had fibrocystic changes (70 percent), 10 had cancer (20 percent) and 5 with indefinite results. CONCLUSION: The overall cancer detection yield for mammography in those without a palpable breast mass, 7271 (7323-52) persons, was extrapolated to be 0.28 percent (20/7271). The authors deemed the information obtained in this study would be useful to the public, health care administrators and health care providers in reviewing the indication and cost-effectiveness of mammography.

Evaluation & Management of Non-palpable Breast Lesions / 한국유방암학회지

PURPOSE: The aim of this study was to achieve early detection, accurate diagnosis and adequate management of suspicious non-palpable breast lesions. METHODS: From January 1998 to March 2002, 86 cases of ultrasonoguided needle biopsies, 121 cases of mammographically guided needle localization biopsies and 75 cases of ultrasonographically guided needle localization biospsies were performed for a total of 282 cases of nonpalpable breast lesions. RESULTS: The age of patients ranged from 30 to 71 years with a mean age of 46.4 years. 56 cases out of a total 282 cases (20%) were found to be malignant (39.3% of those malignancies were carcinomas in situ, and 60.7% were invasive carcinomas). On a mammogram, 15.1% of the microcalcifications were found to be malignant. 31.6% of mass-like lesions and 20% of masses with microcalcifications were found to be malignant. On an ultrasonogram, 42.7% of the microcalcifications were found to be malignant. 21.1% of mass-like lesions, 30% of intraductal masses, and 31.6% of masses with microcalcifications were found to be malignant. 73.5% of all the cases of non-palpable breast cancer were found in stage 0 or 1. CONCLUSION: Non-palpable breast cancers are smaller in size and have lower chances of axillary lymph node involvement compared to palpable breast cancers. Because it is non-palpable, an early diagnosis is hard to achieve. However, once an early diagnosis is made, it could result in better prognosis. Therefore, the selection of adequate diagnostic modalities, the development of better localization methods, and training of precise surgical skill are important.

Efficacy of Hooked-Wire Needle Localization for Nonpalpable Breast Lesions

PURPOSE: The more frequent use of screening mammography, along with improved imaging equipment and techniques, is today resulting in an increasing detection rate for suspicious nonpalpable lesion and thus an increasing need for needle localizations and biopsies. We evaluate the efficacy of hooked-wire fine needle localization. METHODS: From August 1992 to August 1999, 146 hooked-wire needle biopsies were performed at our institution for nonpalpable mammographically detected abnormalities. Specimen roentgenographies were done in all cases. The clinical datas, including mammographic findings and pathologic results, were reviewed retrospectively. RESULTS: Patients ranged in age from 13 to 74 years (a mean of 45.7 years). Of the total 146 cases, 23 (15.7%) were found to be malignants (52.2 percent of these malignancies were carcinomas in situ and 47.8 percent were invasive carcinoma). The chance of a biopsy containing a malignant lesion was 17.2 percent if the biopsy was done for a microcalcification found on a mammograms, 7.7 percent for mass densities, and 28.6 percent if both were present. Benign pathological lesions were proven in 123 cases (84.3%) of the total 146 cases. The most common benign lesion was fibrocystic disease. A minor complication of the hooked-wire needle insertion occurred in one patient who had a hematoma requiring evacuation. Three patients experienced faintness, dizziness, and syncope during needle localization. The morbidity and the mortality rates for biopsies of the breast were nil. CONCLUSION: These results suggest that hooked-wire needle localization for nonpalpable lesion in the breast is a most useful diagnostic modality.

The Role of a Needle Localization Breast Biopsy for the Diagnosis of Nonpalpable Breast Cancer

PURPOSES: Efforts directed at early detection of breast cancer have resulted in an increased incidence of nonpalpable mammographic lesions that warrant excisional biopsy. The most common localization method is the needle-localization biopsy. The aims of this study were to evaluate the effectiveness and the usefulness of a needle localization biopsy in the diagnostic work-up of nonpalpable mammographic abnormalities that are suspected of being cancerous, and to determine the frequency of malignancy detection as well as the incidence of noninvasive carcinoma. METHODS: One hundred seventy eight needle-localization biopsies of nonpalpable breast lesions were performed at Samsung Medical Center from January 1995 to December 1999. A retrospective review was undertaken to assess histopathologic findings based on mammographic abnormalities, as well as pathologic staging and the treatment of breast cancer detected by needle-localization biopsy. RESULTS: Needle-localization biopsies led to the diagnosis of malignancy in 29.8% of the biopsies. Of the malignancies detected, 81.2% were in-situ carcinomas. Invasive carcinomas were less than 2 cm in size (T1) in 70% of the cases and were 2 to 5 cm (T2) in 30% of the cases; there were no evidence of lymph node metastases in 70% of the cases. Overall, 90.6% of the patients were found to be within pathologic stage 0 or stage 1. Microcalcifications only were more related with DCIS than mass density with or without microcalcifications findings. Fine linear, branching, granular, pleomorphic microcalcifications findings and ill defined, irregular, spiculated mass densities were likely to result in higher rate of malignancy. CONCLUSION: It is concluded that needle- localization breast biopsy of nonpalpable suspicious mammographic lesions is an important and effective method for the detection of early breast cancer and noninvasive carcinomas. Appropriate selection ofcases for needle localization biopsy should be made to avoid unnecessary breast biopsies and to increase the percentage of early breast cancer.

The Role of Needle Localization Breast Biopsy for the Diagnosis of Nonpalpable Breast Cancer / 한국유방암학회지

Purposes: Efforts directed at early detection of breast cancer have resulted in an increased incidence of nonpalpable mammographic lesions that warrant excisional biopsy. The most common localization method is the needle-localization biopsy. The aims of this study were to evaluate the effectiveness and the usefulness of needle-localization biopsy in the diagnostic work-up of nonpalpable mammographic abnormalities that are suspected of being cancerous, and to determine the frequency of malignancy detection and the incidence of noninvasive carcinoma. Materials and METHODS: One hundred seventy eight needle-localization biopsies of nonlpalpable breast lesions were performed at Samsung Medical Canter from January 1995 to December 1999. A retrospective review was undertaken to assess histopathologic findings based on mammorgraphic abnormalities, as well as the pathologic staging and the treatment of breast cancer detected by needle-localization biopsy. RESULTS: Needle-localization biopsies led to the diagnosis of malignancy in 29.8% of the biopsies. Of the malignancies detected, 81.2% were in-situcarcinoma. Invasive carcinoma were less than 2cm in size(T1) in 70% of the cases and were 2 to 5cm(T2) in 30% of the cases; there were no evidence of lymph node metastases in 70% of th cases. Overall, 90.6% of the patients were found to be within pathologic stage 0 or stage 1. Microcalcifications only were more related with DCIS than mass density with or without microcalcifications findings. Fine linear, branching, granular, pleomorphic microcalcifications findings and ill defined, irregular, spiculated mass densities were likely to result in higher rate of malignancy. CONCLUSIONS: It is concluded that needle-localization breast biopsy of nonpalpable suspicious mammographic lesions is an important and effective method for the detection of early breast cancer and noninvasive carcinomas. Appropriate selection of cases for needle localization biopsy should be made to avoid unnecessary breast biopsies and to increase the percentage of early breast cancer.

Advanced Breast Biopsy Instrumentation: Stereotactic Excisional Breast Biopsy for Nonpalpable Lesions

BACKGROUND: Stereotactic core biopsy has been advocated as an alternative to open biopsies with needle localization which had been the mainstay of treatment for evaluating nonpalpable mammographic abnormalities. Recently, the ABBI (Advanced Breast Biopsy Instrumentation) system was developed. It enables complete removal of the entire lesion with local anesthesia and ambulatory care. METHODS: We analysed our results for 110 cases of nonpalpable mammographic lesions revealed by stereotactic core biopsies using a 14-gauge needle (n=42) or stereotactic excisional biopsy using the ABBI system (n=68) since December 1997 at the Samsung Medical Center. RESULTS: Of the 110 cases, 13 cases of malignancy were diagnosed, including 9 cases (69%) of DCIS (ductal carcinoma in situ). The pathologic results of the 6 cancers revealed by stereotactic core biopsy had same as the results from the surgical specimens including 5 DCIS and one infiltrating ductal carcinoma. Of the 7 cancers revealed by the ABBI system 4 were DCIS, 1 was LCIS (lobular carcinoma in situ), 1 was an infiltrating ductal carcinoma, and 1 was a mucinous carcinoma. Needle localization biopsy was performed in 5 patients who had benign results from the stereotactic core biopsy, despite the existence of mammographically suspicious lesions. Of these, 2 DCIS cases were finally revealed. CONCLUSIONS: The ABBI system is more ideal than stereotactic core biopsy and allows the advantageous replacement of needle localization and excisional biopsy in selected patients.

Needle Localization Biopsy of Nonpalpable lesions of Breast under the Local Anesthesia

In performing needle localization breast biopsies(NLBB) under local anesthesia in an outpatient setting, we investigated, whether complication rates would be acceptable when compared with complications of the breast performed for palpable masses. We were also interested in determining whether our rate of missed biopsies would be acceptable or not. We performed the NLBB on 55 patients with a nonpalpable breast lesion, and open biopsy on 98 patients with a palpable breast mass under local anesthesia from 1992 to 1995. The missed biopsy rate was one (1.8%) of 55. Complication of NLBB occured in 4 cases(7.3%), including 1 case of seroma, 2 cases of hematoma, and 1 case of abscess. The complication rate was not statistically different from NLBB(7.3%) and open biopsy(6.1%). (P=0.25) Eleven carcinomas, including 8 cases of invasive and 3 cases of DCIS, were found with NLBB procedure.. But there was no in situ carcinoma among the palpable lesions. Needle localization breast biopsies can be performed under local anesthesia and complications rates were similar to those associated with biopsies of palpable lesions. But missed biopsy could occur if the localization was not performed exactly.