Chen Xiaoming, Lehman Constance D, Dee Katherine E
Department of Radiology, University of Washington Medical Center, 1959 NE Pacific, Seattle, WA 98195, USA.
AJR Am J Roentgenol. 2004 Apr;182(4):1075-80. doi: 10.2214/ajr.182.4.1821075.
Core needle biopsy has proven advantages for wire localization and excision; however, MRI-guided core biopsy has been limited by less satisfactory sampling efficiency and less availability of MRI-compatible biopsy needles. We evaluated the feasibility and diagnostic yield of MRI-guided biopsy using 14-gauge stainless steel core biopsy needles and MRI-compatible coaxial sheaths in a closed 1.5-T scanner.
Thirty-five consecutive breast biopsies performed in 29 women between March 2001 and August 2002 were retrospectively reviewed. For each procedure, an MRI-compatible sheath was placed under MRI guidance using a dedicated breast coil and biopsy guidance system. With the patient out of the magnet, a 14-gauge steel core biopsy needle was used to obtain multiple samples. Lesion characteristics, including size, morphology, and enhancement, were recorded. Histology of all the lesions was obtained; and surgical, imaging, or clinical follow-up was performed.
Targeted masses and enhancing foci ranged from 3 to 17 mm. Regional enhancement ranged from 14 to 70 mm. Thirty-four of the 35 biopsies were technically successful. Histology revealed malignancy in eight lesions (23%), atypical ductal hyperplasia in five lesions (14%), and benign entities in 21 lesions (60%). Surgery confirmed all eight core biopsies with malignant findings. Two of five lesions with atypical ductal hyperplasia were upgraded to malignancy after surgery.
This new method of MRI-guided breast biopsy with a 14-gauge stainless steel core biopsy needle and a closed 1.5-T MRI scanner is feasible, safe, and effective and produces satisfactory diagnostic yield. This method offers an alternative to MRI-guided wire localization and to MRI-guided core biopsy with nonferrous needles.
粗针活检已被证明在导丝定位和切除方面具有优势；然而，MRI引导下的粗针活检受到采样效率不尽人意以及MRI兼容活检针可用性较低的限制。我们在一台封闭的1.5T扫描仪中，评估了使用14号不锈钢粗针活检针和MRI兼容同轴鞘进行MRI引导活检的可行性和诊断率。
回顾性分析了2001年3月至2002年8月期间对29名女性连续进行的35例乳腺活检。对于每例手术，使用专用乳腺线圈和活检引导系统在MRI引导下放置一个MRI兼容鞘。患者离开磁体后，使用14号钢质粗针活检针获取多个样本。记录病变特征，包括大小、形态和强化情况。获取所有病变的组织学结果，并进行手术、影像学或临床随访。
靶向肿块和强化灶大小在3至17毫米之间。区域强化范围在14至70毫米之间。35例活检中有34例在技术上成功。组织学检查显示8个病变为恶性（23%），5个病变为非典型导管增生（14%），21个病变为良性（60%）。手术证实了所有8例有恶性发现的粗针活检结果。5例非典型导管增生病变中有2例在手术后升级为恶性。
这种使用14号不锈钢粗针活检针和封闭1.5T MRI扫描仪进行MRI引导下乳腺活检的新方法是可行、安全且有效的，诊断率令人满意。该方法为MRI引导下导丝定位和使用有色金属针进行MRI引导下粗针活检提供了一种替代方案。
