MRI-guided intervention for breast lesions using the freehand technique in a 3.0-T closed-bore MRI scanner: feasibility and initial results

Abstract

Objective: To report the feasibility of magnetic resonance imaging (MRI)-guided intervention for diagnosing suspicious breast lesions detectable by MRI only, using the freehand technique with a 3.0-T closed-bore MRI scanner.

Materials and methods: Five women with 5 consecutive MRI-only breast lesions underwent MRI-guided intervention: 3 underwent MRI-guided needle localization and 2, MRI-guided vacuum-assisted biopsy. The interventions were performed in a 3.0-T closed-bore MRI system using a dedicated phased-array breast coil with the patients in the prone position; the freehand technique was used. Technical success and histopathologic outcome were analyzed.

Results: MRI showed that four lesions were masses (mean size, 11.5 mm; range, 7-18 mm); and 1, a nonmass-like enhancement (maximum diameter, 21 mm). The locations of the lesions with respect to the breast with index cancer were as follows: different quadrant, same breast - 3 cases; same quadrant, same breast - 1 case; and contralateral breast - 1 case. Histopathologic evaluation of the lesions treated with needle localization disclosed perilobular hemangioma, fibrocystic change, and fibroadenomatous change. The lesions treated with vacuum-assisted biopsy demonstrated a radial scar and atypical apocrine hyperplasia. Follow-up MRI after 2-7 months (mean, 4.6 months) confirmed complete lesion removal in all cases.

Conclusion: MRI-guided intervention for breast lesions using the freehand technique with a 3.0-T closed-bore MRI scanner is feasible and accurate for diagnosing MRI-only lesions.

Keywords: Biopsy; Breast neoplasms; Freehand technique; High field; Magnetic resonance imaging; Needle localization.

Fig. 1

Breast MRI equipment and technique. Patient was placed in prone position (A) on dedicated phased-array bilateral breast coil. Handheld MRI-guided biopsy device (arrows in B) was introduced into coaxial sheath (arrow in C) to acquire tissue specimens.

Fig. 2

60-year-old woman diagnosed with invasive ductal carcinoma in left breast after US-guided core needle biopsy. A, B. Preoperative MRI scan shows 1.0 cm ill-defined irregular early-enhancing mass (arrow) in right breast on sagittal post Gd-enhanced fat-suppressed T1-weighted image (A) and axial non-enhanced T1-weighted image, which was not seen in second-look US. To exclude bilateral breast cancer, MRI-guided vacuum-assisted biopsy was performed. C. Noncontrast axial T1-weighted image before needle placement showed lesion with low T1 signal intensity (arrow) under skin marker (arrowhead). D, E. Nonenhanced axial T1-weighted images following needle placement showed that needle tip (arrow) was advanced to edge of lesion, ideal position for accurate sampling. F, G. Axial and sagittal contrast-enhanced images confirmed correct needle placement (arrows). H. Post-biopsy, sagittal fat-suppressed T1-weighted image showed high signal intensity surrounding needle due to hematoma, air, and anesthetic (arrows). Pathologic examination of cores indicated atypical apocrine hyperplasia. This high-risk lesion was referred to surgery following US-guided needle localization for hematoma at site of previous biopsy. No residual lesion was found on pathologic examination. US = ultrasound

Fig. 3

56-year-old woman diagnosed with invasive ductal carcinoma in left breast after US-guided core needle biopsy. A. Sagittal T1-weighted contrast-enhanced MR image shows 11-mm ill-defined irregular early-enhancing mass (arrowhead) in different quadrant of same breast with index cancer. No corresponding lesion was detected on second-look US. To exclude multicentric growth, MRI-guided tissue sampling was performed by needle localization followed by surgical excision. B, C. Sagittal (B) and axial (C) contrast-enhanced images obtained after needle placement showed needle tip (arrow) just anterior to enhancing mass (arrowhead). Lesion was successfully localized and excisional biopsy showed fibroadenomatous changes. US = ultrasound