Fast MRI-Guided Vacuum-Assisted Breast Biopsy: Initial Experience
Laura Liberman1,
Elizabeth A. Morris1,
D. David Dershaw1,
Cynthia M. Thornton1,
Kimberly J. Van Zee2 and
Lee K. Tan3
1 Department of Radiology, Breast Imaging Section, Memorial Sloan-Kettering
Cancer Center, 1275 York Ave., New York, NY 10021.
2 Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY
10021.
3 Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY
10021.
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Fig. 1A. —Equipment and technique for MRI-guided vacuum-assisted
biopsy. Photograph shows MRI-guided vacuum-assisted biopsy needle. Note
collecting area ("mouth") (arrow) of needle.
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Fig. 1B. —Equipment and technique for MRI-guided vacuum-assisted
biopsy. Photograph shows patient positioned with breast in biopsy compression
device. Vitamin E marker has been taped over area of lesion, as determined by
review of MRI study.
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Fig. 1C. —Equipment and technique for MRI-guided vacuum-assisted
biopsy. Photograph shows radiologist measuring obturator (straight
arrow), which is composed of clear plastic, in white introducer sheath.
Black depth stop (curved arrow) is set so that distance between depth
stop and tip of obturator is equal to depth of lesion plus 20 mm.
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Fig. 1D. —Equipment and technique for MRI-guided vacuum-assisted
biopsy. Photograph shows preparation of stylet in white introducer sheath
after depth stop has been set.
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Fig. 1E. —Equipment and technique for MRI-guided vacuum-assisted
biopsy. Photograph shows insertion of stylet into breast through needle
guide.
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Fig. 1F. —Equipment and technique for MRI-guided vacuum-assisted
biopsy. Photograph shows radiologist obtaining biopsy specimens.
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Fig. 1G. —Equipment and technique for MRI-guided vacuum-assisted
biopsy. Photograph shows clip placement through biopsy device.
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Fig. 2A. —34-year-old woman with history of left mastectomy and
reconstruction and right breast augmentation who presented with enhancing mass
on MRI of right breast. Axial localizing MRI of both breasts shows patient has
had left mastectomy and reconstruction and has right breast implant. Vitamin E
marker (arrow) was placed over expected lesion site in right
breast.
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Fig. 2B. —34-year-old woman with history of left mastectomy and
reconstruction and right breast augmentation who presented with enhancing mass
on MRI of right breast. Sagittal T1-weighted contrast-enhanced image of right
breast shows enhancing mass (arrow) measuring 0.6 cm in retroareolar
region.
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Fig. 2C. —34-year-old woman with history of left mastectomy and
reconstruction and right breast augmentation who presented with enhancing mass
on MRI of right breast. Sagittal T1-weighted contrast-enhanced image of right
breast shows indentation from grid evident as low-signal-intensity lines at
skin surface. High signal from vitamin E marker (arrow) is seen.
Scrolling back and forth from MRI of grid and vitamin E marker to MRI of
lesion enables determination of appropriate needle entry site and depth of
insertion.
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Fig. 2D. —34-year-old woman with history of left mastectomy and
reconstruction and right breast augmentation who presented with enhancing mass
on MRI of right breast. Sagittal T1-weighted contrast-enhanced image of right
breast shows obturator (arrow) posterior to lesion.
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Fig. 2E. —34-year-old woman with history of left mastectomy and
reconstruction and right breast augmentation who presented with enhancing mass
on MRI of right breast. Sagittal T1-weighted contrast-enhanced image of right
breast after vacuum-assisted biopsy shows air and hematoma at biopsy site.
Note air–fluid level (arrows) in prone patient with air in
nondependent position. Enhancing mass is no longer seen.
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Fig. 2F. —34-year-old woman with history of left mastectomy and
reconstruction and right breast augmentation who presented with enhancing mass
on MRI of right breast. Sagittal T1-weighted contrast-enhanced image of right
breast after clip placement shows localizing clip evident as low-signal
artifact (curved arrow) at posterior aspect of biopsy cavity. Note
clip appears similar to smaller low-signal foci of air (straight
arrows).
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Fig. 2G. —34-year-old woman with history of left mastectomy and
reconstruction and right breast augmentation who presented with enhancing mass
on MRI of right breast. Sagittal T1-weighted contrast-enhanced image of right
breast after placement of localizing needle shows needle at anterior aspect of
biopsy cavity (open arrow). Clip is again seen at posterior aspect of
biopsy cavity (solid arrow).
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Fig. 2H. —34-year-old woman with history of left mastectomy and
reconstruction and right breast augmentation who presented with enhancing mass
on MRI of right breast. Collimated mediolateral oblique mammographic image of
right breast shows localizing wire and clip. Small amount of air is seen at
biopsy site.
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Fig. 2I. —34-year-old woman with history of left mastectomy and
reconstruction and right breast augmentation who presented with enhancing mass
on MRI of right breast. Specimen radiograph shows retrieval of localizing wire
and clip in collagen pledget. Histologic analysis of vacuum-assisted biopsy
specimens yielded mammary sclerosing adenosis, stromal fibrosis, and
fibroadenomatoid hyperplasia. Surgical excision showed mammary sclerosing
adenosis and stromal fibrosis.
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Fig. 3A. —49-year-old woman with history of lobular carcinoma in situ.
Sagittal T1-weighted contrast-enhanced image of left breast shows enhancing
mass measuring 0.7 cm in left upper outer quadrant (arrow). Lesion
was posterior to biopsy compression grid.
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Fig. 3B. —49-year-old woman with history of lobular carcinoma in situ.
Sagittal T1-weighted contrast-enhanced image of left breast after
vacuum-assisted biopsy shows air and hematoma at biopsy site. Note
air–fluid level in biopsy cavity (arrows). Enhancing mass is no
longer evident.
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Fig. 3C. —49-year-old woman with history of lobular carcinoma in situ.
Sagittal T1-weighted contrast-enhanced image after clip placement shows
low-signal artifact representing clip (arrow). Histologic analysis of
vacuum-assisted biopsy specimens showed infiltrating lobular carcinoma.
Surgical excision showed stromal fibrosis and fresh hemorrhage, consistent
with recent biopsy; no residual carcinoma was identified.
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Fig. 4A. —49-year-old woman with history of lobular carcinoma in situ
(LCIS). Sagittal T1-weighted contrast-enhanced image of right breast shows
heterogeneous regional enhancement (arrows) spanning 5.0 cm.
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Fig. 4B. —49-year-old woman with history of lobular carcinoma in situ
(LCIS). Sagittal T1-weighted contrast-enhanced image of right breast after
vacuum-assisted biopsy shows air (arrow) at biopsy site. Anterior
aspect of lesion has been sampled. Note washout of contrast material from
lesion and progressive enhancement of parenchyma, decreasing lesion
conspicuity. Histologic analysis of vacuum-assisted biopsy specimens revealed
markedly atypical ductal hyperplasia arising in background of radial
sclerosing lesions and columnar cell change, as well as LCIS involving areas
of mammary sclerosing adenosis. Surgical excision yielded low-grade cribriform
ductal carcinoma in situ, markedly atypical ductal hyperplasia arising in
background of mammary sclerosing adenosis and columnar cell change, and
extensive LCIS.
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Fig. 5A. —56-year-old woman with recent skin biopsy showing Paget's
disease of left nipple. Sagittal T1-weighted contrast-enhanced image of left
breast shows lobulated, circumscribed, rim-enhancing mass at 3-o'clock axis
(arrow).
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Fig. 5B. —56-year-old woman with recent skin biopsy showing Paget's
disease of left nipple. Sagittal T1-weighted contrast-enhanced image of left
breast shows low-signal artifact from obturator at site of 3-o'clock axis
lesion (straight arrow). Second lesion (curved arrow) is
more apparent superiorly.
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Fig. 5C. —56-year-old woman with recent skin biopsy showing Paget's
disease of left nipple. Sagittal T1-weighted contrast-enhanced image of left
breast after vacuum-assisted biopsy shows air at biopsy site (straight
open arrow) and air dissecting inferiorly (curved open arrow).
Inferior lesion is no longer evident, but superior lesion (solid
arrow) is still seen. Superior lesion had needle localization without
vacuum-assisted biopsy, yielding fibroadenoma and stromal fibrosis. Inferior
lesion yielded fibroadenoma and stromal fibrosis at vacuum-assisted biopsy;
surgical excision showed fibrosis and few scattered foci of ductal carcinoma
in situ at anterior margin of resection.
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Copyright © 2003 by the American Roentgen Ray Society.
