PDF(Pubmed)
Abstract：
OBJECTIVE: Breast magnetic resonance imaging (MRI) can detect some malignant lesions that are not visible on mammography (MX) or ultrasound (US). If a targeted, second-look fails, MRI-guided breast biopsy is the only available tool to obtain a tissue sample and pathological proof of these \"MRI-only lesions\". The aim of this study is to report the performance and underestimation rate of 9G MRI-guided vacuum-assisted breast biopsy (VABB) over 12 years at a single center.
METHODS: All 9G MRI-VABB procedures performed from January 2010 to December 2021 were retrospectively reviewed. Two MRI scanners (1.5 T and 3 T) were used with the same image resolution and contrast media. All suspicious lesions detected only by breast MRI underwent biopsy. Reference standard was histological diagnosis or at least 1-year negative follow-up. All malignant and atypical lesions underwent surgery, which was used as the reference standard.
RESULTS: A total of 293 biopsies were retrospectively reviewed. Histopathological VABB results revealed 142/293 (48.4%) benign lesions, 77/293 (26.2%) high-risk lesions, and 74/293 (25.2%) malignant lesions. No significant complications were observed. Surgical pathology results allowed for the reclassification of n = 7/48 B3b lesions: n = 4 were ductal carcinoma in situ, while n = 3 presented invasive features at surgical histology (2 IDC; 1 ILC). B3b underestimation occurred overall in 14.6% of B3 cases. Breast follow-up was achieved for all benign VABB results, and only one false-negative case was observed.
CONCLUSIONS: Our results confirm that 1.5 T and 3 T MRI-guided VABB is an accurate and safe procedure for histopathologic final diagnosis of MRI-only lesions. Critical issues remain the potential high-risk underestimation rate of B3b VABB results and management of follow-up of benign lesions.
METHODS: All 9G MRI-VABB procedures performed from January 2010 to December 2021 were retrospectively reviewed. Two MRI scanners (1.5 T and 3 T) were used with the same image resolution and contrast media. All suspicious lesions detected only by breast MRI underwent biopsy. Reference standard was histological diagnosis or at least 1-year negative follow-up. All malignant and atypical lesions underwent surgery, which was used as the reference standard.
RESULTS: A total of 293 biopsies were retrospectively reviewed. Histopathological VABB results revealed 142/293 (48.4%) benign lesions, 77/293 (26.2%) high-risk lesions, and 74/293 (25.2%) malignant lesions. No significant complications were observed. Surgical pathology results allowed for the reclassification of n = 7/48 B3b lesions: n = 4 were ductal carcinoma in situ, while n = 3 presented invasive features at surgical histology (2 IDC; 1 ILC). B3b underestimation occurred overall in 14.6% of B3 cases. Breast follow-up was achieved for all benign VABB results, and only one false-negative case was observed.
CONCLUSIONS: Our results confirm that 1.5 T and 3 T MRI-guided VABB is an accurate and safe procedure for histopathologic final diagnosis of MRI-only lesions. Critical issues remain the potential high-risk underestimation rate of B3b VABB results and management of follow-up of benign lesions.
摘要：
目的：乳腺磁共振成像（MRI）可以检测出一些在乳房X线照相术（MX）或超声检查（US）上看不到的恶性病变。如果有针对性的,第二次看失败，MRI引导的乳腺活检是获得这些“仅MRI病变”的组织样本和病理证据的唯一可用工具。这项研究的目的是报告9GMRI引导的真空辅助乳腺活检（VABB）在单个中心的12年内的性能和低估率。
方法：回顾性分析2010年1月至2021年12月进行的所有9GMRI-VABB手术。使用具有相同图像分辨率和造影剂的两台MRI扫描仪（1.5T和3T）。仅通过乳腺MRI检测到的所有可疑病变均进行了活检。参考标准是组织学诊断或至少1年的阴性随访。所有恶性和不典型病变均接受手术治疗,用作参考标准。
结果：回顾性分析了293例活检。组织病理学VABB结果显示142/293（48.4％）良性病变，77/293（26.2%）高危病变，74/293（25.2%）恶性病变。无明显并发症发生。手术病理结果允许n=7/48B3b病变的重新分类：n=4为导管原位癌，而n=3在手术组织学上呈现侵入性特征(2个IDC；1个ILC)。B3b低估发生在14.6%的B3病例中。对所有良性VABB结果进行乳腺随访，仅观察到一例假阴性。
结论：我们的结果证实，1.5T和3TMRI引导的VABB是一种准确和安全的方法，用于组织病理学最终诊断仅MRI病变。关键问题仍然是B3bVABB结果的潜在高风险低估率和良性病变的随访管理。
方法：回顾性分析2010年1月至2021年12月进行的所有9GMRI-VABB手术。使用具有相同图像分辨率和造影剂的两台MRI扫描仪（1.5T和3T）。仅通过乳腺MRI检测到的所有可疑病变均进行了活检。参考标准是组织学诊断或至少1年的阴性随访。所有恶性和不典型病变均接受手术治疗,用作参考标准。
结果：回顾性分析了293例活检。组织病理学VABB结果显示142/293（48.4％）良性病变，77/293（26.2%）高危病变，74/293（25.2%）恶性病变。无明显并发症发生。手术病理结果允许n=7/48B3b病变的重新分类：n=4为导管原位癌，而n=3在手术组织学上呈现侵入性特征(2个IDC；1个ILC)。B3b低估发生在14.6%的B3病例中。对所有良性VABB结果进行乳腺随访，仅观察到一例假阴性。
结论：我们的结果证实，1.5T和3TMRI引导的VABB是一种准确和安全的方法，用于组织病理学最终诊断仅MRI病变。关键问题仍然是B3bVABB结果的潜在高风险低估率和良性病变的随访管理。
