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MR-Guided Vacuum-Assisted Biopsy
Wendie A. Berg, MD, PhD, FACR, FSBI
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KEY FACTS

  • Preprocedure

    • Procedure

      • Post Procedure

        • Outcomes

          TERMINOLOGY

          • Definitions

            • Percutaneous MR-guided biopsy of suspicious breast MR finding using vacuum-assisted devices
              • Biopsy itself typically performed outside magnet (unless open bore)
              • MR used to identify lesion and confirm plastic cannula tip at edge of lesion
            • May be performed either with grid or free-hand
            • Obturator: MR-compatible plastic stylet, often impregnated with Gd, used to confirm proper placement of coaxial cannula at target
            • Trocar: Metallic stylet to aid insertion of plastic cannula
            • Fiducial: T1-hyperintense marker on skin surface (vitamin E or fish oil capsule, Gd-impregnated marker)
            • Grid: Fenestrated compression paddle
            • Template: Paper, clear sheet of film, or software to record location of lesion with respect to fiducial
              • Facilitates translation of images as viewed on scanner to prone position of patient

          PREPROCEDURE

          • Indications

            • Contraindications

              • Getting Started

                PROCEDURE

                • Patient Position/Location

                  • Procedure Steps

                    • Findings and Reporting

                      • Alternative Procedures/Therapies

                        POST PROCEDURE

                        • Expected Outcome

                          • Things to Do

                            OUTCOMES

                            • Problems

                              • Complications

                                Selected References

                                1. Pinnamaneni N et al: Canceled MRI-guided Breast Biopsies Due to Nonvisualization: Follow-up and Outcomes. Acad Radiol. ePub, 2018
                                2. Huang ML et al: Imaging-concordant benign MRI-guided vacuum-assisted breast biopsy may not warrant MRI follow-up. AJR Am J Roentgenol. 208(4):916-922, 2017
                                3. Maglione KD et al: Radiologic-pathologic correlation for benign results after MRI-guided breast biopsy. AJR Am J Roentgenol. 209(2):442-453, 2017
                                4. Verheyden C et al: Underestimation rate at MR imaging-guided vacuum-assisted breast biopsy: A multi-institutional retrospective study of 1509 breast biopsies. Radiology. 281(3):708-719, 2016
                                5. Spick C et al: Diagnostic utility of second-look US for breast lesions identified at MR imaging: systematic review and meta-analysis. Radiology. 273(2):401-9, 2014
                                6. Brennan SB et al: Papilloma diagnosed at MRI-guided vacuum-assisted breast biopsy: is surgical excision still warranted? AJR Am J Roentgenol. 199(4):W512-9, 2012
                                7. Meeuwis C et al: MR-guided breast biopsy at 3T: diagnostic yield of large core needle biopsy compared with vacuum-assisted biopsy. Eur Radiol. 22(2):341-9, 2012
                                8. Brennan SB et al: Cancellation of MR imaging-guided breast biopsy due to lesion nonvisualization: frequency and follow-up. Radiology. 261(1):92-9, 2011
                                9. Crystal P et al: High-risk lesions diagnosed at MRI-guided vacuum-assisted breast biopsy: can underestimation be predicted? Eur Radiol. 21(3):582-9, 2011
                                10. Meeuwis C et al: MRI-guided breast biopsy at 3T using a dedicated large core biopsy set: feasibility and initial results. Eur J Radiol. 79(2):257-61, 2011
                                11. Li J et al: MRI follow-up after concordant, histologically benign diagnosis of breast lesions sampled by MRI-guided biopsy. AJR Am J Roentgenol. 193(3):850-5, 2009
                                12. Meissnitzer M et al: Targeted ultrasound of the breast in women with abnormal MRI findings for whom biopsy has been recommended. AJR Am J Roentgenol. 193(4):1025-9, 2009
                                13. Peters NH et al: Feasibility of MRI-guided large-core-needle biopsy of suspiscious breast lesions at 3 T. Eur Radiol. 19(7):1639-44, 2009
                                14. Han BK et al: Outcome of MRI-guided breast biopsy. AJR Am J Roentgenol. 191(6):1798-804, 2008
                                15. Lee JM et al: Complete excision of the MRI target lesion at MRI-guided vacuum-assisted biopsy of breast cancer. AJR Am J Roentgenol. 191(4):1198-202, 2008
                                16. Lee JM et al: Imaging histologic discordance at MRI-guided 9-gauge vacuum-assisted breast biopsy. AJR Am J Roentgenol. 189(4):852-9, 2007
                                17. Lee JM et al: Underestimation of DCIS at MRI-guided vacuum-assisted breast biopsy. AJR Am J Roentgenol. 189(2):468-74, 2007
                                18. Liberman L et al: Underestimation of atypical ductal hyperplasia at MRI-guided 9-gauge vacuum-assisted breast biopsy. AJR Am J Roentgenol. 188(3):684-90, 2007
                                19. Meeuwis C et al: Targeting difficult accessible breast lesions: MRI-guided needle localization using a freehand technique in a 3.0 T closed bore magnet. Eur J Radiol. 62(2):283-8, 2007
                                20. Ghate SV et al: MRI-guided vacuum-assisted breast biopsy with a handheld portable biopsy system. AJR Am J Roentgenol. 186(6):1733-6, 2006
                                21. Liberman L et al: Does size matter? Positive predictive value of MRI-detected breast lesions as a function of lesion size. AJR Am J Roentgenol. 186(2):426-30, 2006
                                22. Orel SG et al: MR imaging-guided 9-gauge vacuum-assisted core-needle breast biopsy: initial experience. Radiology. 238(1):54-61, 2006
                                23. Perlet C et al: Magnetic resonance-guided, vacuum-assisted breast biopsy: results from a European multicenter study of 538 lesions. Cancer. 106(5):982-90, 2006
                                24. Beran L et al: Correlation of targeted ultrasound with magnetic resonance imaging abnormalities of the breast. Am J Surg. 190(4):592-4, 2005
                                25. Lehman CD et al: Clinical experience with MRI-guided vacuum-assisted breast biopsy. AJR Am J Roentgenol. 184(6):1782-7, 2005
                                26. Liberman L et al: MRI-guided 9-gauge vacuum-assisted breast biopsy: initial clinical experience. AJR Am J Roentgenol. 185(1):183-93, 2005
                                27. Morris EA et al: Breast MRI: Diagnosis and Intervention. 1st ed. New York: Springer. 297-315, 2005
                                28. Sim LS et al: US correlation for MRI-detected breast lesions in women with familial risk of breast cancer. Clin Radiol. 60(7):801-6, 2005
                                29. Hefler L et al: Follow-up of breast lesions detected by MRI not biopsied due to absent enhancement of contrast medium. Eur Radiol. 13(2):344-6, 2003
                                30. LaTrenta LR et al: Breast lesions detected with MR imaging: utility and histopathologic importance of identification with US. Radiology. 227(3):856-61, 2003
                                Related Anatomy
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                                Related Differential Diagnoses
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                                References
                                Tables

                                Tables

                                KEY FACTS

                                • Preprocedure

                                  • Procedure

                                    • Post Procedure

                                      • Outcomes

                                        TERMINOLOGY

                                        • Definitions

                                          • Percutaneous MR-guided biopsy of suspicious breast MR finding using vacuum-assisted devices
                                            • Biopsy itself typically performed outside magnet (unless open bore)
                                            • MR used to identify lesion and confirm plastic cannula tip at edge of lesion
                                          • May be performed either with grid or free-hand
                                          • Obturator: MR-compatible plastic stylet, often impregnated with Gd, used to confirm proper placement of coaxial cannula at target
                                          • Trocar: Metallic stylet to aid insertion of plastic cannula
                                          • Fiducial: T1-hyperintense marker on skin surface (vitamin E or fish oil capsule, Gd-impregnated marker)
                                          • Grid: Fenestrated compression paddle
                                          • Template: Paper, clear sheet of film, or software to record location of lesion with respect to fiducial
                                            • Facilitates translation of images as viewed on scanner to prone position of patient

                                        PREPROCEDURE

                                        • Indications

                                          • Contraindications

                                            • Getting Started

                                              PROCEDURE

                                              • Patient Position/Location

                                                • Procedure Steps

                                                  • Findings and Reporting

                                                    • Alternative Procedures/Therapies

                                                      POST PROCEDURE

                                                      • Expected Outcome

                                                        • Things to Do

                                                          OUTCOMES

                                                          • Problems

                                                            • Complications

                                                              Selected References

                                                              1. Pinnamaneni N et al: Canceled MRI-guided Breast Biopsies Due to Nonvisualization: Follow-up and Outcomes. Acad Radiol. ePub, 2018
                                                              2. Huang ML et al: Imaging-concordant benign MRI-guided vacuum-assisted breast biopsy may not warrant MRI follow-up. AJR Am J Roentgenol. 208(4):916-922, 2017
                                                              3. Maglione KD et al: Radiologic-pathologic correlation for benign results after MRI-guided breast biopsy. AJR Am J Roentgenol. 209(2):442-453, 2017
                                                              4. Verheyden C et al: Underestimation rate at MR imaging-guided vacuum-assisted breast biopsy: A multi-institutional retrospective study of 1509 breast biopsies. Radiology. 281(3):708-719, 2016
                                                              5. Spick C et al: Diagnostic utility of second-look US for breast lesions identified at MR imaging: systematic review and meta-analysis. Radiology. 273(2):401-9, 2014
                                                              6. Brennan SB et al: Papilloma diagnosed at MRI-guided vacuum-assisted breast biopsy: is surgical excision still warranted? AJR Am J Roentgenol. 199(4):W512-9, 2012
                                                              7. Meeuwis C et al: MR-guided breast biopsy at 3T: diagnostic yield of large core needle biopsy compared with vacuum-assisted biopsy. Eur Radiol. 22(2):341-9, 2012
                                                              8. Brennan SB et al: Cancellation of MR imaging-guided breast biopsy due to lesion nonvisualization: frequency and follow-up. Radiology. 261(1):92-9, 2011
                                                              9. Crystal P et al: High-risk lesions diagnosed at MRI-guided vacuum-assisted breast biopsy: can underestimation be predicted? Eur Radiol. 21(3):582-9, 2011
                                                              10. Meeuwis C et al: MRI-guided breast biopsy at 3T using a dedicated large core biopsy set: feasibility and initial results. Eur J Radiol. 79(2):257-61, 2011
                                                              11. Li J et al: MRI follow-up after concordant, histologically benign diagnosis of breast lesions sampled by MRI-guided biopsy. AJR Am J Roentgenol. 193(3):850-5, 2009
                                                              12. Meissnitzer M et al: Targeted ultrasound of the breast in women with abnormal MRI findings for whom biopsy has been recommended. AJR Am J Roentgenol. 193(4):1025-9, 2009
                                                              13. Peters NH et al: Feasibility of MRI-guided large-core-needle biopsy of suspiscious breast lesions at 3 T. Eur Radiol. 19(7):1639-44, 2009
                                                              14. Han BK et al: Outcome of MRI-guided breast biopsy. AJR Am J Roentgenol. 191(6):1798-804, 2008
                                                              15. Lee JM et al: Complete excision of the MRI target lesion at MRI-guided vacuum-assisted biopsy of breast cancer. AJR Am J Roentgenol. 191(4):1198-202, 2008
                                                              16. Lee JM et al: Imaging histologic discordance at MRI-guided 9-gauge vacuum-assisted breast biopsy. AJR Am J Roentgenol. 189(4):852-9, 2007
                                                              17. Lee JM et al: Underestimation of DCIS at MRI-guided vacuum-assisted breast biopsy. AJR Am J Roentgenol. 189(2):468-74, 2007
                                                              18. Liberman L et al: Underestimation of atypical ductal hyperplasia at MRI-guided 9-gauge vacuum-assisted breast biopsy. AJR Am J Roentgenol. 188(3):684-90, 2007
                                                              19. Meeuwis C et al: Targeting difficult accessible breast lesions: MRI-guided needle localization using a freehand technique in a 3.0 T closed bore magnet. Eur J Radiol. 62(2):283-8, 2007
                                                              20. Ghate SV et al: MRI-guided vacuum-assisted breast biopsy with a handheld portable biopsy system. AJR Am J Roentgenol. 186(6):1733-6, 2006
                                                              21. Liberman L et al: Does size matter? Positive predictive value of MRI-detected breast lesions as a function of lesion size. AJR Am J Roentgenol. 186(2):426-30, 2006
                                                              22. Orel SG et al: MR imaging-guided 9-gauge vacuum-assisted core-needle breast biopsy: initial experience. Radiology. 238(1):54-61, 2006
                                                              23. Perlet C et al: Magnetic resonance-guided, vacuum-assisted breast biopsy: results from a European multicenter study of 538 lesions. Cancer. 106(5):982-90, 2006
                                                              24. Beran L et al: Correlation of targeted ultrasound with magnetic resonance imaging abnormalities of the breast. Am J Surg. 190(4):592-4, 2005
                                                              25. Lehman CD et al: Clinical experience with MRI-guided vacuum-assisted breast biopsy. AJR Am J Roentgenol. 184(6):1782-7, 2005
                                                              26. Liberman L et al: MRI-guided 9-gauge vacuum-assisted breast biopsy: initial clinical experience. AJR Am J Roentgenol. 185(1):183-93, 2005
                                                              27. Morris EA et al: Breast MRI: Diagnosis and Intervention. 1st ed. New York: Springer. 297-315, 2005
                                                              28. Sim LS et al: US correlation for MRI-detected breast lesions in women with familial risk of breast cancer. Clin Radiol. 60(7):801-6, 2005
                                                              29. Hefler L et al: Follow-up of breast lesions detected by MRI not biopsied due to absent enhancement of contrast medium. Eur Radiol. 13(2):344-6, 2003
                                                              30. LaTrenta LR et al: Breast lesions detected with MR imaging: utility and histopathologic importance of identification with US. Radiology. 227(3):856-61, 2003