Abstract: A growing body of referred studies have found that a significant number of patients undergoing breast biopsies present with multiple areas of interest.

A growing body of studies have found that a significant number of patients undergoing MRI-guided breast biopsies present with multiple areas of interest. The Suros ATEC system provides the ability to biospy patients with multiple lesions in a single gadolinium injection.

Laura Liberman¹, Elizabeth A. Morris¹, D. David Dershaw¹, Cynthia M. Thornton¹, Kimberly J. Van Zee² and Lee K. Tan³ "Fast MRI-Guided Vacuum-Assisted Breast Biopsy: Initial Experience" AJR 2003; 181:1283-1293

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.

OBJECTIVE. The purpose of this study was to evaluate a new method for performing MRI-guided vacuum-assisted breast biopsy in a study of lesions that had subsequent surgical excision.

SUBJECTS AND METHODS. Twenty women scheduled for MRI-guided needle localization and surgical biopsy were prospectively entered in the study. MRI-guided biopsy was performed with a vacuum-assisted probe, followed by placement of a localizing clip, and then needle localization for surgical excision. Vacuum-assisted biopsy and surgical histology were correlated.

RESULTS. Vacuum-assisted biopsy was successfully performed in 19 (95%) of the 20 women. The median size of 27 MRI-detected lesions that had biopsy was 1.0 cm (range, 0.4-6.4 cm). Cancer was present in eight (30%) of 27 lesions and in six (32%) of 19 women; among these eight cancers, five were infiltrating and three were ductal carcinoma in situ (DCIS). Among these 27 lesions, histology was benign at vacuum-assisted biopsy and at surgery in 19 (70%), cancer at vacuum-assisted biopsy in six (22%), atypical ductal hyperplasia at vacuum-assisted biopsy and DCIS at surgery in one (4%), and benign at vacuum-assisted biopsy with surgery showing microscopic DCIS that was occult at MRI in one (4%). The median time to perform vacuum-assisted biopsy of a single lesion was 35 min (mean, 35 min; range, 24-48 min). Placement of a localizing clip, attempted in 26 lesions, was successful in 25 (96%) of 26, and the clip was retrieved on specimen radiography in 22 (96%) of 23. One complication occurred: a hematoma that resolved with compression.

CONCLUSION. MRI-guided vacuum-assisted biopsy is a fast, safe, and accurate alternative to surgical biopsy for breast lesions detected on MRI.

Constance D. Lehman^1,2, Elizabeth R. DePeri³, Sue Peacock^1,2, Michelle D. McDonough³, Wendy B. DeMartini^1,2 and Jennifer Shook^1,2 "Clinical Experience with MRI-Guided Vacuum-Assisted Breast Biopsy" " AJR 2005; 84:1782-787

¹ Department of Radiology, University of Washington Medical Center, 1959 NE Pacific, Seattle, WA 98195.
² Breast Imaging, Seattle Cancer Care Alliance, 825 Eastlake Ave. E, G4-830, Seattle, WA 98109-1023.
³ Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224.

OBJECTIVE. The objective of our study was to evaluate a new commercially available method of MRI-guided vacuum-assisted breast biopsy using an open coil and a closed 1.5-T scanner.

MATERIALS AND METHODS. Consecutive MRI-guided vacuum-assisted breast biopsies of 38 lesions in 28 women performed between May and September 2003 at two practice sites in the United States were retrospectively reviewed. Lesion characteristics including size, morphology, and enhancement were recorded. Times to perform each procedure, defined as the time from the start of the first localizing scan to the final scan after biopsy, were recorded. Histologic results for all lesions were obtained, and surgical, imaging, or clinical follow-up was performed.

RESULTS. Enhancing masses and foci ranged from 2.5 to 19 mm. Nonmasslike enhancements ranged from 6 to 70 mm. All 38 biopsies (100%) were technically successful, and no complications were associated with any of the biopsy procedures. The average time to perform the 19 single-site MRI-guided procedures was 38 min (range, 23-57 min). The 11 multiple-site biopsies performed in a single breast averaged 59 min (range, 51-68 min), and eight bilateral biopsies averaged 64 min (range, 46-80 min). Histologic results from vacuum-assisted breast biopsy revealed malignancy in 14 lesions (37%), atypical ductal hyperplasia in two lesions (5%), and benign findings in 22 lesions (58%). One of two lesions with atypical ductal hyperplasia was upgraded to ductal carcinoma in situ after surgery, for an overall cancer yield of 40% (15/38).

CONCLUSION. This new method of MRI-guided vacuum-assisted breast biopsy is a safe, effective, and time-efficient means of MRI-guided tissue sampling.

Laura Liberman, Nanette Bracero, Elizabeth Morris, Cynthia Thornton and D. David Dershaw "MRI-Guided 9-Gauge Vacuum-Assisted Breast Biopsy: Initial Clinical Experience" " AJR 2005; 185:183-193

Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10021.

OBJECTIVE. The objective of this study was to evaluate our initial clinical experience with MRI-guided vacuum-assisted breast biopsy as an alternative to surgical excision.

MATERIALS AND METHODS. A retrospective review revealed 112 consecutive nonpalpable, mammographically occult MRI-detected breast lesions scheduled for MRI-guided vacuum-assisted biopsy. Biopsy was performed with a 9-gauge vacuum-assisted biopsy probe (Suros Surgical Systems) followed by clip placement (Artemis Medical). Medical records and histologic findings were reviewed.

RESULTS. Among 112 lesions, biopsy was cancelled because of nonvisualization of the lesion in 14 (12%). Of the remaining 98 lesions, tissue was successfully acquired in 95 (97%). The median number of specimens obtained was 12 (range, 6-20). The median time to perform MRI-guided biopsy was 33 min for one lesion and 56 min for two lesions. Histology in 95 lesions was benign and concordant in 52 (55%), cancer in 24 (25%), high-risk in 10 (11%), and discordant in nine (9%). MRI-guided biopsy histologies in 24 cancers were ductal carcinoma in situ in 13 (54%) and infiltrating carcinoma in 11 (46%). Seven additional cancers were found at surgery in four discordant lesions and in three high-risk lesions. The clip successfully deployed in 86 (95%) of 91 lesions. Six complications (three hematomas, two instances in which the biopsy probe pierced the skin on the far side of the breast, and one vasovagal reaction) resolved without sequelae.

CONCLUSION. MRI-guided vacuum-assisted biopsy is a fast and safe alternative to surgical biopsy for MRI-detected breast lesions. Imaging-histologic correlation is necessary to ensure lesion sampling.