MR-Guided Breast Intervention

Abstract

The role of magnetic resonance (MR) imaging for diagnosing and staging of breast cancer is ever increasing. It has been shown that MR imaging can detect breast cancer that is occult on mammography, ultrasound, and clinical examination. With the increasing use of breast MR imaging, there is an increasing number of women who require an MR-guided intervention for lesions that are visible with breast MR imaging alone, i.e., that are occult on mammography and on second-look ultrasound. Until recently, MR-guided needle localization with subsequent surgical biopsy has been the standard technique to deal with this situation. During the last years, MR-guided breast biopsy is available and is gaining more and more importance in the management of only MR visible lesions. But MR-guided breast biopsy is a challenging endeavor for many reasons, including the requirement for equipment that will work in the MR imaging environment, need to remove the patient from the magnet to perform biopsy in closed systems, limited access to the medial and posterior part of the breast, decreasing lesion conspicuity with time after contrast injection (vanishing phenomenon), and difficulties confirming lesion retrieval. Semiautomatic core biopsy under MR guidance has been successfully performed, but for a variety of reasons did not gain broad clinical acceptance. MR-guided vacuum biopsy, however, is a technique that allows a more accurate and successful tissue sampling of lesions seen only on MR imaging. This chapter gives an overview about procedures and results of MR-guided breast needle localization and MR-guided breast biopsy using semiautomatic core needles and vacuum-assisted biopsy probes.