Download PDF
Rofo 2014; 186(1): 30-36
DOI: 10.1055/s-0033-1335972
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Management of Breast Lesions Detectable Only on MRI

Abklärung ausschließlich MRT-detektierbarer Mammaläsionen
K. C. Siegmann-Luz
,
S. D. Bahrs
,
H. Preibsch
,
V. Hattermann
,
C. D. Claussen
Further Information

Publication History

06 November 2012

21 May 2013

Publication Date:
29 July 2013 (online)

Also available at
   Permissions and Reprints

Abstract

Breast MR imaging has become established as the most sensitive imaging method for diagnosing breast cancer. As a result of the increasing examination volume and improved image quality, the number of breast lesions detected only on MRI and requiring further clarification has risen in recent years. According to the S3-guideline “Diagnosis, Therapy, and Follow-Up of Breast Cancer” as revised in July 2012, institutions performing breast MRI should provide the option of an MRI-guided intervention for clarification. This review describes the indications, methods and results of MRI-guided interventions for the clarification of breast lesions only visible on MRI. Recent guidelines and study results are also addressed and alternative methods and pitfalls are presented.

Key points:

  • Up to 57 % of lesions originally visible only on MRI can be sonographically correlated and biopsied.

  • MRI-guided intervention is necessary for the clarification of BI-RADS® 4 and 5 lesions detectable only on MRI

  • MRI-guided vacuum-assisted breast biopsy should be preferentially used

  • MRI-guided localization and surgical excision should be used if MRI-guided vacuum-assisted biopsy is not possible

  • If BI-RADS® 4 and 5 findings visible only on MRI are not detectable on interventional MRI, a follow-up MRI should be performed within six months

Citation Format:

  • Siegmann-Luz KC, Bahrs SD, Preibsch H et al. Management of Breast Lesions Detectable Only on MRI. Fortschr Röntgenstr 2014; 186: 30 – 36

Zusammenfassung

Die Mamma-MRT (Magnetresonanztomografie) hat sich als sensitivste bildgebende Methode in der Senologie etabliert. Durch steigende Untersuchungszahlen und verbesserte Bildqualität ist in den letzten Jahren ein Anstieg von abklärungsbedürftigen, ausschließlich MRT-detektierten Mammaläsionen zu verzeichnen. Die im Juli 2012 aktualisierte S3-Leitlinie „Diagnostik, Therapie und Nachsorge des Mammakarzinoms“ empfiehlt, dass alle Institute, die diagnostische MR-Mammografien durchführen, die Möglichkeit zur MRT-gestützten interventionellen Abklärung vorhalten sollen. Die vorliegende Übersicht beschreibt Indikationen, Methoden und Ergebnisse MRT-gestützter Interventionen zur Abklärung ausschließlich MRT-sichtbarer Mammaläsionen. Dabei werden aktuelle Leitlinien und Studienergebnisse berücksichtigt und alternative Abklärungsmethoden und Pitfalls aufgezeigt.

Key words

breast - MR imaging - interventional MRI

Deutscher Artikel/German Article

 

  • Literature

  • 1 Hrung JM, Sonnad SS, Schwartz JS et al. Accuracy of MR imaging in the work-up of suspicious breast lesions: a diagnostic meta-analysis. Acad Radiol 1999; 6: 387-397
    CrossrefPubMedGoogle Scholar
  • 2 Peters NH, Borel RinkesIH, Zuithoff NP et al. Meta-analysis of MR imaging in the diagnosis of breast lesions. Radiology 2008; 246: 116-124
    CrossrefPubMedGoogle Scholar
  • 3 Heywang-Köbrunner SH, Heinig A, Schaumlöffel U et al. MR-guided percutaneous excisional and incisional biopsy of breast lesions. Eur Radiol 1999; 9: 1656-1665
    CrossrefPubMedGoogle Scholar
  • 4 Leitlinienprogramm Onkologie der AWMF, Deutschen Krebsgesellschaft e. V. und Deutschen Krebshilfe e.V (eds). Interdisziplinäre S3-Leitlinie für die Diagnostik, Therapie und Nachsorge des Mammakarzinoms. 3. Auflage. Germering/München: Zuckerschwerdt; 2012
    Google Scholar
  • 5 Heywang-Köbrunner SH, Sinnatamby R, Lebeau A et al. Interdisciplinary consensus on the uses and technique of MR-guided vacuum-assisted breast biopsy (VAB): results of a European consensus meeting. Eur J Radiol 2009; 72: 289-294
    CrossrefPubMedGoogle Scholar
  • 6 American College of Radiology (ACR). Breast Imaging Reporting and Data System Atlas (BI-RADS® Atlas). Reston, Va: © American College of Radiology; 2003. http://www.acr.org/Quality-Safety/Resources/BIRADS/Mammography
    Google Scholar
  • 7 Fischer U, Kopka L, Grabbe E. Breast Carcinoma: Effect of preoperative contrast-enhanced MR Imaging on the therapeutic approach. Radiology 1999; 213: 881-888
    CrossrefPubMedGoogle Scholar
  • 8 Siegmann KC, Moron HU, Baur A et al. Diagnostische Wertigkeit des Göttinger Scores zur Malignitätsvorhersage von ausschließlich in der MRT darstellbaren Mammaläsionen. Fortschr Röntgenstr 2009; 181: 1-8
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Dietzel M, Baltzer PA, Vag T et al. Magnetic resonance mammography in small vs. advanced breast lesions – systematic comparison reveals significant impact of lesion size on diagnostic accuracy in 936 histologically verified breast lesions. Fortschr Röntgenstr 2011; 183: 126-135
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Abe H, Schmidt RA, Shah RN et al. MR-directed (“second-look”) ultrasound examination for breast lesions detected initially on MRI: MR and sonographic findings. Am J Roentgenol 2010; 194: 370-377
    CrossrefPubMedGoogle Scholar
  • 11 Demartini WB, Eby PR, Peacock S et al. Utility of targeted sonography for breast lesions that were suspicious on MRI. Am J Roentgenol 2009; 192: 1128-1134
    CrossrefPubMedGoogle Scholar
  • 12 Meissnitzer M, Dershaw DD, Lee CH et al. Targeted ultrasound of the breast in women with abnormal MRI findings for whom biopsy has been recommended. Am J Roentgenol 2009; 193: 1025-1029
    CrossrefPubMedGoogle Scholar
  • 13 LaTrenta LR, Menell JH, Morris EA et al. Breast lesions detected with MR imaging: utility and histopathologic importance of identification with US. Radiology 2003; 227: 856-861
    CrossrefPubMedGoogle Scholar
  • 14 Kuhl C. The current status of breast MR imaging. Part I. Choice of technique, image interpretation, diagnostic accuracy, and transfer to clinical practice. Radiology 2007; 244: 356-378
    CrossrefPubMedGoogle Scholar
  • 15 Fischer U. Qualitätssicherung „MR-gesteuerte Interventionen”. Empfehlungen der AG Mammadiagnostik der Deutschen Röntgengesellschaft, Konsensus 02/2007. http://apps.drg.de/mammaAG/QS_MRM_Intervention.pdf
    PubMedGoogle Scholar
  • 16 Müller-Schimpfle MP, Heindel W, Kettritz U et al. Konsensustreffen der Kursleiter in der Mammadiagnstik am 7.5.2011 in Frankfurt am Main – Magnet-Resonanz-Tomografie der Mamma. Fortschr Röntgenstr 2012; 184: 919-924
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Fischer U, Rodenwaldt J, Hundertmark C et al. MRT-gestützte Biopsie und Lokalisation der Mamma. Radiologe 1997; 37: 692-701
    CrossrefPubMedGoogle Scholar
  • 18 Poellinger A, Bick U, Freund T et al. Evaluation of 11-gauge and 9-gauge vacuum-assisted breast biopsy systems in a breast parenchymal model. Acad Radiol 2007; 14: 677-684
    CrossrefPubMedGoogle Scholar
  • 19 Hauth EA, Jaeger HJ, Lubnau J et al. MR-guided vacuum-assisted breast biopsy with a handheld biopsy system: clinical experience and results in postinterventional MR mammography after 24h. Eur Radiol 2008; 18: 168-176
    CrossrefPubMedGoogle Scholar
  • 20 Perlet C, Sittek H, Reiser M et al. Clipmarkierung nach MRT-gesteuerter Vakuumbiopsie der Mamma. Radiologe 2005; 45: 230-236
    CrossrefPubMedGoogle Scholar
  • 21 Baltzer PA, Dietzel M, Vag T et al. Clinical MR mammography: impact of hormonal status on background enhancement and diagnostic accuracy. Fortschr Röntgenstr 2011; 183: 441-447
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Delille JP, Slanetz PJ, Yeh ED et al. Physiologic changes in breast magnetic resonance imaging during the menstrual cycle: perfusion imaging, signal enhancement, and influence of the T1 relaxation time of breast tissue. Breast J 2005; 11: 236-241
    CrossrefPubMedGoogle Scholar
  • 23 Sardanelli F, Boetes C, Borisch B et al. Magnetic resonance imaging of the breast: recommendations from the EUSOMA working group. Eur J Cancer 2010; 46: 1296-1316
    CrossrefPubMedGoogle Scholar
  • 24 Ojeda-Fournier H, Choe KA, Mahoney MC. Recognizing and interpreting artifacts and pitfalls in MR imaging of the breast. Radiographics 2007; 27 (Suppl. 01) S147-164
    CrossrefPubMedGoogle Scholar
  • 25 Perlet C, Schneider P, Amaya B et al. MR-Guided vacuum biopsy of 206 contrast-enhancing breast lesions. Fortschr Röntgenstr 2002; 174: 88-95
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Perlet C, Heinig A, Prat X et al. Multicenter study for the evaluation of a dedicated biopsy device for MR-guided vacuum biopsy of the breast. Eur Radiol 2002; 12: 1463-1470
    CrossrefPubMedGoogle Scholar
  • 27 Hefler L, Casselman J, Amaya B et al. Follow-up of breast lesions detected by MRI not biopsied due to absent enhancement of contrast medium. Eur Radiol 2003; 13: 344-346
    PubMedGoogle Scholar
  • 28 Fischer U, Schwethelm L, Baum FT et al. Aufwand, Zuverlässigkeit und histologische Ergebnisse der MR-gesteuerten Vakuumbiopsie suspekter Mammabefunde – retrospektive Auswertung von 389 Interventionen. Fortschr Röntgenstr 2009; 181: 774-781
    Article in Thieme ConnectPubMedGoogle Scholar
  • 29 Brennan SB, Sung JS, Dershaw DD et al. Cancellation of MR imaging-guided breast biopsy due to lesion nonvisualization: frequency and follow-up. Radiology 2011; 261: 92-99
    CrossrefPubMedGoogle Scholar
  • 30 Kuhl CK, Elevelt A, Leutner CC et al. Interventional breast MR imaging: clinical use of a stereotactic localization and biopsy device. Radiology 1997; 204: 667-675
    CrossrefPubMedGoogle Scholar
  • 31 Viehweg P, Heinig A, Amya B et al. MR-guided interventional breast procedures considering vacuum biopsy in particular. Eur J Radiol 2002; 42: 32-39
    CrossrefPubMedGoogle Scholar
  • 32 Lehman CD, Blume JD, Thickman D et al. Added cancer yield of MRI in screening the contralateral breast of women recently diagnosed with breast cancer: results from the International Breast Magnetic Resonance Consortium (IBMC) trial. J Surg Oncol 2005; 92: 9-15
    CrossrefPubMedGoogle Scholar
  • 33 Lehman CD et al. MRI evaluation of the contralateral breast in women with recently diagnosed breast cancer. N Engl J Med 2007; 356: 1295-1303
    CrossrefPubMedGoogle Scholar
  • 34 Liberman L, Mason G, Morris EA et al. Does size matter? Positive predictive value of MR-detected breast lesions as a function of lesion size. Am J Roentgenol 2006; 186: 426-430
    CrossrefPubMedGoogle Scholar
  • 35 Perlet C, Heywang-Köbrunner SH, Heinig A et al. Magnetic resonance-guided, vacuum-assisted breast biopsy: results from a European multicenter study of 538 lesions. Cancer 2006; 106: 982-990
    CrossrefPubMedGoogle Scholar
  • 36 Obenauer S, Grabbe E, Knollmann F. Stellenwert der MR-gestützten Lokalisation und Biopsie von Brustläsionen. Fortschr Röntgenstr 2006; 178: 477-483
    Article in Thieme ConnectPubMedGoogle Scholar
  • 37 Fischer U, Kopka L, Grabbe E. Magnetic resonance guided localization and biopsy of suspicious breast lesion. Top Magn Reson Imaging 1998; 9: 44-59
    PubMedGoogle Scholar
  • 38 Schneider JP, Schulz T, Rüger S et al. MRT-gestüzte Markierung und Stanzbiopsie suspekter Mammaläsionen. Radiologe 2002; 42: 33-41
    CrossrefPubMedGoogle Scholar
  • 39 Liberman L, Bracero N, Morris E et al. MR-guided 9-gauge vacuum-assisted breast biopsy: initial clinical experience. Am J Roentgenol 2005; 185: 183-193
    CrossrefPubMedGoogle Scholar
  • 40 Orel SG, Rosen M, Mies C et al. MR imaging-guided 9-gauge vacuum-assisted core-needle breast biopsy: initial experience. Radiology 2006; 238: 54-61
    CrossrefPubMedGoogle Scholar
  • 41 Mahoney MC. Initial clinical experience with a new MRI vacuum-assisted breast biopsy device. J Magn Reson Imaging 2008; 28: 900-905
    CrossrefPubMedGoogle Scholar
  • 42 Malhaire C, El Khoury C, Thibault F et al. Vacuum-assisted biopsies under MR guidance: results of 72 procedures. Eur Radiol 2010; 20: 1554-1562
    CrossrefPubMedGoogle Scholar
  • 43 Oxner CR, Vora L, Yim J et al. Magnetic resonance imaging-guided breast biopsy in lesions not visualized by mammogram or ultrasound. Am Surg 2012; 78: 1087-1090
    PubMedGoogle Scholar
  • 44 Kettritz U, Morack G, Decker T. Stereotactic vacuum-assisted breast biopsies in 500 women with microcalcifications: radiological and pathological correlations. Eur J Radiol 2005; 55: 270-276
    CrossrefPubMedGoogle Scholar
  • 45 Salem C, Sakr R, Chopier J et al. Pain and complications of directional vacuum-assisted stereotactic biopsy: comparison of the Mammotome and Vacora techniques. Eur J Radiol 2009; 72: 295-299
    CrossrefPubMedGoogle Scholar