1. MRI guided breast biopsies dr. Marc B.I. Lobbes, MD, PhD, EBBI
Parkstad Mamma Symposium
Heerlen – 17 mei 2019

6. ’Second look’ / target echografie
Results of studies vary: %, pooled rate 57.5% (95% CI %)
More often succesfull for masses and/or malignancies
However: (pooled) 12.2% of lesions not found is still malignant
So: negative target US cannot rule out breast cancer
Options: image fusion or additional breast tomosynthesis?
Spick C, et al. Radiology 2014; 273:

7. Checklist prior to MRI guided biopsy
All imaging available, including targeted ultrasound?
Tolerate prolonged immobilization for minutes
Contra-indications: MRI, lesions location, anti-coagulants, breast implants L M
Heywang-Köbrunner S, et al. Eur J Radiol 2009; 72:

8. Quality of breast MRI guided biopsy
Use of a VAB system, minimal needle size 11 Gauge
Minimum amount of samples is 24 or equal volume
Marker placement is recommended, checked with mammography
Minimum procedures 15, followed by at least 10 procedures annually
Proper imaging / pathology correlation in MDT
Heywang-Köbrunner S, et al. Eur J Radiol 2009; 72:

9. Quality of breast MRI guided biopsy
Heywang-Köbrunner S, et al. Eur J Radiol 2009; 72:

11. Example case

15. Non visualisation of lesions during MRI guided biopsy
Cancellation of procedure occurs in 8% (70/907 procedures)
Influencing factors: BPE, breast density, lesions <1 cm
In 58/70 cases with MRI follow-up: no cancers occured
Cancer detection rate with any follow-up: 2%
So: at least MRI follow-up is recommend (6 months)
Brennan S, et al. Radiology 2011; 261: 92-99

16. Contact information dr. Marc B.I. Lobbes, MD, PhD, EBBI Maastricht UMC+, dep. Radiology and NM Per July 1st: Zuyderland Medical Center, dep. Radiology