Gao Yiming, Bagadiya Neeti R, Jardon Meghan L, Heller Samantha L, Melsaether Amy N, Toth Hildegard B, Moy Linda
1 Department of Radiology, New York University Langone Medical Center, 160 E 34th St, New York, NY 10016.
2 Center for Advanced Imaging Innovation and Research, New York University School of Medicine, New York, NY.
AJR Am J Roentgenol. 2016 Sep;207(3):676-84. doi: 10.2214/AJR.15.15913. Epub 2016 Jun 8.
MRI-guided needle localization allows access to MRI-detected mammographically occult breast lesions that are not amenable to MRI-guided biopsy. The purpose of this study was to examine the safety and outcomes of MRI-guided needle localization.
Ninety-nine consecutive breast lesions that underwent preoperative MRI-guided needle localization were identified. Clinical indications for breast MRI, reasons for performing MRI-guided needle localization, and surgical pathology results were recorded. Lesion characteristics, procedure time, and complications were assessed.
Of 99 lesions, 60 (60.6%) were in a location inaccessible for MRI biopsy, necessitating MRI-guided needle localization. Histologic evaluation revealed 38 (38.4%) carcinomas, 31 (31.3%) high-risk lesions, and 30 (30.3%) benign lesions. Carcinoma was more likely to be found in women with known cancer (31/61 [50.8%]; p = 0.003) than in women undergoing imaging for high-risk screening (2/18 [11.1%]) or problem solving (6/20 [30%]). Masses (p = 0.013) and foci (p < 0.001) were more likely to be malignant than were lesions with nonmass enhancement. Foci were significantly more often malignant compared with all other lesion types (9/10 [90%]; p < 0.001). The mean (± SD) procedure time was 32.9 ± 9.39 minutes. All lesions were occult on specimen radiographs. There were no procedure-related complications.
The positive predictive value of MRI-guided needle localization (38.4%) is comparable to that of mammography- and tomosynthesis-guided localizations and is highest in women with a known diagnosis of cancer. It is highly accurate in targeting small enhancing lesions, thereby improving surgical management. MRI-guided needle localization is a safe, accurate, and time-efficient procedure.
MRI引导下的针定位可用于获取MRI检测到的乳腺钼靶隐匿性病变，这些病变不适用于MRI引导下的活检。本研究的目的是检查MRI引导下针定位的安全性和结果。
确定99例连续接受术前MRI引导下针定位的乳腺病变。记录乳腺MRI的临床指征、进行MRI引导下针定位的原因以及手术病理结果。评估病变特征、手术时间和并发症。
99个病变中，60个（60.6%）位于MRI活检无法到达的位置，需要进行MRI引导下针定位。组织学评估显示38个（38.4%）为癌，31个（31.3%）为高危病变，30个（30.3%）为良性病变。已知患有癌症的女性中发现癌的可能性（31/61 [50.8%]；p = 0.003）高于进行高危筛查成像（2/18 [11.1%]）或解决问题成像（6/20 [30%]）的女性。肿块（p = 0.013）和病灶（p < 0.001）比非肿块强化的病变更可能是恶性的。与所有其他病变类型相比，病灶明显更常为恶性（9/10 [90%]；p < 0.001）。平均（±标准差）手术时间为32.9±9.39分钟。所有病变在标本X线片上均为隐匿性。无手术相关并发症。
MRI引导下针定位的阳性预测值（38.4%）与乳腺钼靶和断层合成引导下的定位相当，在已知患有癌症的女性中最高。它在靶向小的强化病变方面高度准确，从而改善手术管理。MRI引导下针定位是一种安全、准确且高效的手术。
