What is the role of MRI-guided biopsy following magnetic resonance mammography (breast MRI)?

Updated: Feb 25, 2019
  • Author: Preeti Gupta, MD, FRCR; Chief Editor: Eugene C Lin, MD  more...
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Answer

Answer

MRI-guided biopsy is an inevitable consequence of performing breast MRI, because it can depict lesions that are occult on all other forms of breast imaging and on clinical examination. A number of research centers have confirmed that MRI-guided biopsy is at least practical and that it can be used to verify a malignant diagnosis of otherwise occult neoplasms. [28, 29, 30]

Early breast coils had a completely closed design that precluded needle-based interventions in the breast. Breast coils that have an open design have been developed for routine imaging. These permit free access to the breast for biopsy. Unilateral, dedicated biopsy coils allow complete access to the breast and much of the chest wall and axillae. [31] Several investigators have developed various techniques for MRI-guided fine-needle biopsy or localization. [32, 33, 34, 35, 36, 37, 38, 39] Biopsy needles and hookwires made specifically for breast MR interventions are commercially available. Typically, these devices are non-ferromagnetic, compress the breast mediolaterally, have a perforated needle-guide compression plate, have MRI-visible markers, and use mechanical needle positioning.

User preference and familiarity with conventional image-guided breast biopsy are critical factors for success, regardless of the device and choice of needle-biopsy technology.

Typically, imaging is performed with gentle, mediolateral compression by using compression plates to stabilize the breast. It is important not to apply too much pressure, because this may reduce lesion enhancement, sometimes markedly. [32]

After contrast enhancement and appropriate targeting, the suspicious lesion is biopsied with an MRI-compatible needle. Alternatively, a biopsy clip can be placed or a hookwire can be deployed for subsequent surgical excision.

It is important to determine concordance of the histologic results with biopsied MRI findings. In benign concordant biopsies, a 6-month follow-up breast MRI is recommended.


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