Magnetic Resonance Imaging-guided Breast Biopsies: Tips and Tricks

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Magnetic Resonance Imaging-guided Breast Biopsies: Tips and Tricks Elissa R. Price, MD, Elizabeth A. Morris, MD Canadian Association of Radiologists Journal Volume 62, Issue 1, Pages 15-21 (February 2011) DOI: 10.1016/j.carj.2010.09.001 Copyright © 2011 Canadian Association of Radiologists Terms and Conditions

Figure 1 Segmental non-masslike enhancement in the lower breast seen on screening MRI in high-risk patient. (A) No abnormality was seen on mammography or ultrasound. Skin entry site of MRI-guided biopsy. (B) Obturator in good position within non-masslike enhancement. (C) Extensive non-calcified ductal carcinoma in situ was found on pathology. Canadian Association of Radiologists Journal 2011 62, 15-21DOI: (10.1016/j.carj.2010.09.001) Copyright © 2011 Canadian Association of Radiologists Terms and Conditions

Figure 2 It is essential that the breast be properly positioned within the coil to facilitate easy, safe access for biopsy. Canadian Association of Radiologists Journal 2011 62, 15-21DOI: (10.1016/j.carj.2010.09.001) Copyright © 2011 Canadian Association of Radiologists Terms and Conditions

Figure 3 The left breast has been positioned in the right breast coil to facilitate access to a far posteromedial lesion. Vitamin E capsule was placed on the medial breast surface. Canadian Association of Radiologists Journal 2011 62, 15-21DOI: (10.1016/j.carj.2010.09.001) Copyright © 2011 Canadian Association of Radiologists Terms and Conditions

Figure 4 (A) A grease pen is used to document the position of the fiducials (as marked by the letter B) on a laminated depiction of the compression grid. (B) The laminated sheet is then taken back into the MRI suite to guide proper selection of the skin site to be cleaned and anaesthetized. Canadian Association of Radiologists Journal 2011 62, 15-21DOI: (10.1016/j.carj.2010.09.001) Copyright © 2011 Canadian Association of Radiologists Terms and Conditions

Figure 5 High-signal blood and gadolinium in the biopsy cavity (A) are removed by postbiopsy lavage and aspiration (B), thereby facilitating assessment of sampling adequacy. Canadian Association of Radiologists Journal 2011 62, 15-21DOI: (10.1016/j.carj.2010.09.001) Copyright © 2011 Canadian Association of Radiologists Terms and Conditions

Figure 6 Postbiopsy mammogram is essential to document marker position. In this case, a lesion in the superolateral cone of tissue was biopsied (A and B). (C) Postbiopsy craniocaudal mammogram demonstrates the marker approximately 3 cm medial to the site of biopsy. Canadian Association of Radiologists Journal 2011 62, 15-21DOI: (10.1016/j.carj.2010.09.001) Copyright © 2011 Canadian Association of Radiologists Terms and Conditions

Figure 7 Small enhancing mass in the medial breast (A) was not visible on the day of biopsy (B). The biopsy was canceled and the patient scheduled for follow-up MRI in 6 months' time. Canadian Association of Radiologists Journal 2011 62, 15-21DOI: (10.1016/j.carj.2010.09.001) Copyright © 2011 Canadian Association of Radiologists Terms and Conditions