Purpose

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.

Material and 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.

Conclusion

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.

中文翻译：

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9G MRI引导真空辅助乳腺活检的长期结果：12年来293例单中心手术的结果和高危病变的低估率

目的

乳房磁共振成像 (MRI) 可以检测到一些在乳房 X 线摄影 (MX) 或超声波 (US) 上看不到的恶性病变。如果有针对性的二次检查失败，MRI 引导的乳腺活检是获取这些“仅 MRI 病变”的组织样本和病理证据的唯一可用工具。本研究的目的是报告单个中心 12 年来 9G MRI 引导真空辅助乳腺活检 (VABB) 的表现和低估率。

材料与方法

对 2010 年 1 月至 2021 年 12 月期间进行的所有 9G MRI-VABB 手术进行了回顾性审查。使用两台 MRI 扫描仪（1.5 T 和 3 T），具有相同的图像分辨率和造影剂。所有仅通过乳腺 MRI 检测到的可疑病变均进行了活检。参考标准是组织学诊断或至少1年阴性随访。所有恶性及非典型病变均接受手术治疗，并以此作为参考标准。

结果

总共对 293 份活检进行了回顾性审查。组织病理学VABB结果显示，良性病变为142/293（48.4%），高危病变为77/293（26.2%），恶性病变为74/293（25.2%）。没有观察到明显的并发症。手术病理学结果允许对 n = 7/48 B3b 病变进行重新分类：n = 4 为导管原位癌，而 n = 3 在手术组织学上呈现侵袭性特征（2 个 IDC；1 个 ILC）。 B3b 低估总体发生在 14.6% 的 B3 案例中。对所有良性 VABB 结果均进行了乳房随访，仅观察到 1 例假阴性病例。

结论

我们的结果证实，1.5 T 和 3 T MRI 引导的 VABB 是对仅 MRI 病变进行组织病理学最终诊断的准确且安全的程序。关键问题仍然是 B3b VABB 结果的潜在高风险低估率和良性病变的随访管理。