MRI-Guided Needle Core Biopsies of Breast: Diagnostic Yield in 193 Cases
Paula S Ginter, Abbey J Winant, Syed A Hoda. Weill Cornell Medical College, New York, NY
Background: Magnetic resonance imaging (MRI) is an increasingly employed adjunct to standard breast screening, and is primarily used in high-risk patients. Cumulative data indicate that MRI-guided needle core biopsies of breast (MRI-NCB/B) have relatively high sensitivity but low specificity; however, information regarding diagnostic yield of particular types of lesions detected via this modality remain scant.
Design: MRI-NCB/B performed over a 3.5-year period (2009-2012) were retrieved. All archived slides, and relevant records, were reviewed. Non-mass-like enhancement in high-risk patients was the indication in almost all cases (Fig. A).
Results: 193 MRI-NCB/B, performed in 162 patients, were re-evaluated. 31 patients had multiple (19%) and 9 had bilateral (6%) biopsies. Benign breast findings were present in 147/193 (76%) cases. Invasive mammary carcinoma (ca) was diagnosed in 16 (8%) (ductal: 11, lobular: 4, mucinous: 1), ductal ca in situ (DCIS) in 12 (6%), and lobular ca in situ (LCIS) in 9 (5%). Atypical duct hyperplasia (ADH) was diagnosed in 8 (4%). Benign diagnoses included cystic papillary apocrine hyperplasia: 36 (19%), fibroadenoma: 11 (6%), papilloma: 18 (9%), radial scar: 7 (4%), benign intramammary lymph node: 6 (3%), fat necrosis: 6 (3%), duct ectasia: 5 (3%), and hemangioma: 2 (1%). Some degree of apocrine change was evident in 5 (3%) cases of invasive ca (including in 2 ductal, 2 lobular, and 1 mucinous) and 7 (4%) of DCIS. Apocrine change was evident in benign lesions, including: 14 cases of sclerosing adenosis (apocrine adenosis), 3 of complex fibroadenoma, and 8 of papilloma. Thus, some element of apocrine change was present in association with various benign and malignant lesions in 75 (39%) cases. This relatively common finding of apocrine-related lesions in MRI-NCB/B validates a previously reported (Int J Breast Cancer; 2011; ID 613285) observation.
Conclusions: In this series of 193 cases, the positive-predictive value of MRI-NCB/B was 19%. Invasive carcinoma was diagnosed in 8% and in situ carcinoma in 10%. Cystic papillary apocrine hyperplasia in 19% was the most common histological finding (Fig. B).
The diagnostic yield of MRI-NCB/B in breast screening and the preferential detection of apocrine lesions require further study.
Monday, March 4, 2013 1:00 PM
Poster Session II # 34, Monday Afternoon