Arifa Sadaf MBBS, FRCR, Presenter: Nothing to Disclose

Karina Bukhanov MD, Abstract Co-Author: Nothing to Disclose

David R. McCready MD, Abstract Co-Author: Nothing to Disclose

Frances P O'Malley MBBCH, Abstract Co-Author: Nothing to Disclose

Pavel Crystal MD, Abstract Co-Author: Nothing to Disclose

To determine whether imaging or histologic features of high risk lesions diagnosed at MRI-guided vacuum-assisted breast biopsy (MRgVABB) can be used to predict upgrading to malignancy at subsequent surgical excision.  

REB approved retrospective review of the medical records of patients who underwent MRgVABB over a 3 year period (02/06- 02/09) was performed. All women had biopsies performed with a 9-gauge Suros device on 1.5 Tesla magnet. Women with high risk lesions diagnosed at MRgVABB that subsequently underwent surgical excision comprised the study group. Clinical data, MRI features of the biopsied lesions, procedure related factors, and histological diagnosis of cases with and those without underestimation were compared.

Of 135 MRgVABB, histology revealed 28 high-risk lesions; namely lobular neoplasia (LN) [8],  atypical ductal hyperplasia (ADH) [6], atypical apocrine proliferation [5], benign papilloma [2],  flat epithelial atypia (FEA) [2], and radial scar[3]. Six women with high-risk lesions at MRgVABB declined excisional biopsy. Of 22 excised lesions, 11 (50%) were upgraded to ductal carcinoma in situ.  All MRgVABB were considered technically successful. The proportion of mass (4/11) and non-mass lesions (7/11) was the same in both groups. There was a non-significant trend (p=.08) for larger MRI-measured lesion size in the underestimated cases (mean size 23±16 mm) versus those without underestimation (mean size 13±8 mm). There were no significant differences in morphologic and kinetic MRI features of the biopsied lesions between the two groups. There were no significant difference (p>0.1) in the number of cores between the two groups. The underestimation rates of atypical apocrine proliferation, ADH, LN, and FEA were 100% (5/5), 50% (2/4), 50% (3/6), and 50% (1/2) respectively. There was no underestimation in the cases of benign papilloma without atypia (0/2), and radial scar (0/3).  

The rate of underestimation for high risk breast lesions at MRgVABB was 50 %. Neither morphology nor kinetic MRI features predict high-risk lesions with underestimation at subsequent surgery. All cases with atypia require excisional biopsy, while additional data is required regarding the management of benign papilloma and radial scar diagnosed at MRgVABB.

 To ascertain an appropriate management of high-risk lesions diagnosed at MRgVABB.

Sadaf, A, Bukhanov, K, McCready, D, O'Malley, F, Crystal, P, High Risk Breast Lesions Diagnosed with MRI-Guided Vacuum-Assisted Breast Biopsy (MRgVABB): Can Underestimation be Predicted?.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8012492.html