Findings of Magnetic Resonance Imaging-Guided Breast Biopsy: A Radiologic and Pathologic Correlation Study from a Single Institution
Beverly Lynch, Stephen Seiler, Gregory Moses, Sunati Sahoo. UT Southwestern Medical Center, Dallas, TX
Background: The role of Magnetic Resonance Imaging (MRI) in the diagnosis of breast diseases has rapidly evolved from its initial use of screening high-risk women to a more widespread use in women with newly diagnosed breast cancer. The sensitivity of breast MRI is high and many suspicious lesions detected by MRI will not have corresponding abnormality on mammography and ultrasound examinations. Therefore, a MRI-guided core biopsy is often performed to characterize the suspicious lesions. A detailed correlation of various suspicious categories of MRI findings with histopathology of the breast lesions is still lacking. Our goal is to study the histopathologic findings that are frequently present as abnormal enhancing lesions.
Design: A retrospective review was conducted on all patients undergoing MRI-guided core biopsy during October 2007 to September 2012. Our study population consisted of 140 MRI-guided needle core breast biopsies performed on 130 patients. Biopsies were performed using a 1.5-Tesla Phillips MR with a 9-gauge vacuum-assisted SUROS biopsy device. Histopathologic findings of these biopsies were recorded.
Results: Overall, 25 of 140 (18%) of our MRI-guided breast biopsies were malignant, 16 of 140 (12%) were atypical epithelial hyperplasia, 99 of 140 (71%) were benign. Of the 30 malignant cases, 12 were invasive ductal carcinomas, 4 infiltrating lobular carcinomas, and 9 ductal carcinoma in situ. Of the 16 atypical epithelial hyperplasia, 3 were ADH and 12 were atypical lobular hyperplasia/lobular carcinoma in-situ. All atypical hyperplasias were associated with other benign changes. Interestingly, columnar cell changes accounted for 40% of the benign lesions.
Conclusions: Majority (71%) of our MRI-guided biopsy yielded benign diagnoses; only 18% of the sampled lesions were clinically significant (invasive carcinoma and DCIS). Columnar cell changes are frequently identified within the enhancing lesions. Additional studies focusing on the pattern of enhancement seen in MRI on certain benign and malignant lesions may help to subcategorize lesions for MRI-guided biopsy.
Monday, March 4, 2013 1:30 PM
Proffered Papers: Section B, Monday Afternoon