PURPOSE: To prospectively assess accuracy of mammography, clinical examination, ultrasonography (US), and magnetic resonance (MR) imaging in preoperative assessment of local extent of breast cancer. MATERIALS AND METHODS: Institutional review board approval and informed patient consent were obtained. Results of bilateral mammography, US, and contrast-enhanced MR imaging were analyzed from 111 consecutive women with known or suspected invasive breast cancer. Results were correlated with histopathologic findings. RESULTS: Analysis included 177 malignant foci in 121 cancerous breasts, of which 89 (50%) foci were palpable. Median size of 139 invasive foci was 18 mm (range, 2–107 mm). Mammographic sensitivity decreased from 100% in fatty breasts to 45% in extremely dense breasts. Mammographic sensitivity was highest for invasive ductal carcinoma (IDC) in 89 of 110 (81%) cases versus 10 of 29 (34%) cases of invasive lobular carcinoma (ILC) (P < .001) and 21 of 38 (55%) cases of ductal carcinoma in situ (DCIS) (...

Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer.

ContextCurrent recommendations for women who have a BRCA1 or BRCA2 mutation are to undergo breast surveillance
from age 25 years onward with mammography annually and clinical breast examination
(CBE) every 6 months; however, many tumors are detected at a relatively advanced
stage. Magnetic resonance imaging (MRI) and ultrasound may improve the ability
to detect breast cancer at an early stage.ObjectiveTo compare the sensitivity and specificity of 4 methods of breast cancer
surveillance (mammography, ultrasound, MRI, and CBE) in women with hereditary
susceptibility to breast cancer due to a BRCA1 or BRCA2 mutation.Design, Setting, and ParticipantsA surveillance study of 236 Canadian women aged 25 to 65 years with BRCA1 or BRCA2 mutations who underwent
1 to 3 annual screening examinations, consisting of MRI, mammography, and
ultrasound at a single tertiary care teaching hospital between November 3,
1997, and March 31, 2003. On the day of imaging and at 6-month intervals,
CBE was performed.Main Outcome MeasuresSensitivity and specificity of each of the 4 surveillance modalities,
and sensitivity of all 4 screening modalities vs mammography and CBE.ResultsEach imaging modality was read independently by a radiologist and scored
on a 5-point Breast Imaging Reporting and Data System scale. All lesions with
a score of 4 or 5 (suspicious or highly suspicious for malignancy) were biopsied.
There were 22 cancers detected (16 invasive and 6 ductal carcinoma in situ).
Of these, 17 (77%) were detected by MRI vs 8 (36%) by mammography, 7 (33%)
by ultrasound, and 2 (9.1%) by CBE. The sensitivity and specificity (based
on biopsy rates) were 77% and 95.4% for MRI, 36% and 99.8% for mammography,
33% and 96% for ultrasound, and 9.1% and 99.3% for CBE, respectively. There
was 1 interval cancer. All 4 screening modalities combined had a sensitivity
of 95% vs 45% for mammography and CBE combined.ConclusionsIn BRCA1 and BRCA2 mutation
carriers, MRI is more sensitive for detecting breast cancers than mammography,
ultrasound, or CBE alone. Whether surveillance regimens that include MRI will
reduce mortality from breast cancer in high-risk women requires further investigation.

https://jamanetwork.com/journals/jama/articlepdf/199438/JOC32405.pdf

Surveillance of BRCA1 and BRCA2 mutation carriers with magnetic resonance imaging, ultrasound, mammography, and clinical breast examination.

Geigy Scientific Tables

Compared with mammography and breast ultrasonography, contrast material–enhanced magnetic resonance (MR) imaging is a breast imaging technique that offers not only information on lesion cross-sectional morphology but also on functional lesion features such as tissue perfusion and enhancement kinetics. After an enthusiastic start to clinical breast MR imaging in the early 1990s, a variety of difficulties and obstacles were identified that hampered the transfer of the modality into clinical practice, including a lack of standardization regarding image acquisition and interpretation guidelines, a lack of MR-compatible interventional materials, and a lack of evidence regarding its diagnostic accuracy—particularly specificity and positive predictive value, as well as sensitivity for ductal carcinoma in situ. This article is the first of two on the current status of breast MR imaging. The pathophysiologic basis of breast MR and the effects on acquisition technique and diagnostic accuracy, the diverging demands ...

The current status of breast MR imaging. Part I. Choice of technique, image interpretation, diagnostic accuracy, and transfer to clinical practice.

Purpose: To prospectively compare clinical breast examination (CBE), mammography, ultrasonography (US), and contrast material–enhanced magnetic resonance (MR) imaging for screening women at genetic-familial high risk for breast cancer and report interim results, with pathologic findings as standard. Materials and Methods: Institutional review board of each center approved the research; informed written consent was obtained. CBE, mammography, US, and MR imaging were performed for yearly screening of BRCA1 or BRCA2 mutation carriers, first-degree relatives of BRCA1 or BRCA2 mutation carriers, or women enrolled because of a strong family history of breast or ovarian cancer (three or more events in first- or second-degree relatives in either maternal or paternal line; these included breast cancer in women younger than 60 years, ovarian cancer at any age, and male breast cancer at any age). Results: Two hundred seventy-eight women (mean age, 46 years ± 12 [standard deviation]) were enrolled. Breast cancer was ...

/pdf/multicenter-comparative-multimodality-surveillance-of-women-3ksfqlom4x.pdf

Multicenter Comparative Multimodality Surveillance of Women at Genetic-Familial High Risk for Breast Cancer (HIBCRIT Study): Interim Results

Bilateral dual-energy contrast-enhanced digital mammography was feasible, easily accomplished, and depicted known primary tumors at a rate comparable to that of MR imaging and higher than that of conventional digital mammography.

/pdf/bilateral-contrast-enhanced-dual-energy-digital-mammography-2rthi6hakt.pdf

Bilateral contrast-enhanced dual-energy digital mammography: feasibility and comparison with conventional digital mammography and MR imaging in women with known breast carcinoma.

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%)...

https://www.ajronline.org/doi/pdfplus/10.2214/ajr.185.1.01850183

MRI-Guided 9-Gauge Vacuum-Assisted Breast Biopsy: Initial Clinical Experience

PURPOSE: To assess accuracy and usefulness of placement of a localizing clip after stereotactic, vacuum-assisted breast biopsy. MATERIALS AND METHODS: Retrospective review was performed of 57 lesions that underwent placement of a localizing clip after stereotactic vacuum-assisted biopsy with an 11-gauge (n = 42) or 14-gauge (n = 15) probe. The clip was placed when images obtained after stereotactic biopsy suggested that the lesion seen at mammography was removed. Coordinates of the clip on stereotactic images obtained after placement were compared with lesion coordinates determined before biopsy. Surgery was performed in 25 cases. Mammographic and histopathologic findings were reviewed. RESULTS: The distance from clip to lesion site was less than 1 cm in 40 (95%) of 42 lesions that underwent clip placement with the 11-gauge probe versus 11 (73%) of 15 lesions that underwent clip placement after 14-gauge biopsy (P < .04). The biopsy site was identified in the surgical specimen in 19 (100%) lesions with cli...

Clip placement after stereotactic vacuum-assisted breast biopsy

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-assist...

Fast MRI-guided vacuum-assisted breast biopsy: initial experience.

Screening mammography increases detection of non-palpable breast lesions requiring image-guided localization prior to surgery. Accurate preoperative localization is crucial for successful surgical outcomes. Wire-guided localization is currently the most widely used localization method for non-palpable breast lesions; however, this technique has multiple disadvantages including patient discomfort, possible wire transection and migration, suboptimal surgical incision placement due to wire location and limited scheduling flexibility decreasing operating room efficiency. As a result, promising new techniques including radioactive seed localization, non-radioactive radar localization and magnetic seed localization have been developed as alternatives. In this article, we provide an overview of these techniques and discuss their advantages, drawbacks and currently available outcome data.

/pdf/innovations-in-image-guided-preoperative-breast-lesion-405lazjqqa.pdf

Cynthia M Thornton

Papers

Bilateral contrast-enhanced dual-energy digital mammography: feasibility and comparison with conventional digital mammography and MR imaging in women with known breast carcinoma.

MRI-Guided 9-Gauge Vacuum-Assisted Breast Biopsy: Initial Clinical Experience

Clip placement after stereotactic vacuum-assisted breast biopsy

Fast MRI-guided vacuum-assisted breast biopsy: initial experience.

Innovations in image-guided preoperative breast lesion localization