Gao Peng, Kong Xiangyi, Song Ying, Song Yan, Fang Yi, Ouyang Han, Wang Jing
Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
J Cancer. 2020 May 20;11(16):4671-4682. doi: 10.7150/jca.46329. eCollection 2020.
With a high sensitivity of breast lesions, MRI can detect suspicious lesions which are occult in traditional breast examination equipment. However, the lower and variable specificity of MRI makes the MRI-guided intervention, including biopsies and localizations, necessary before surgery, especially for patients who need the treatment of breast-conserving surgery (BCS). MRI techniques and patient preparation should be first carefully considered before the intervention to avoid lengthening the procedure time and compromising targeting accuracy. Doctors and radiologists need to reconfirm the target of the lesion and be very familiar with the process approach and equipment techniques involving the computer-aided diagnosis (CAD) tools and the biopsy system and follow a correct way. The basic steps of MRI-guided biopsy and localization are nearly the same regardless of the vendor or platform, and this article systematically introduces detailed methods and techniques of MRI-guided intervention. The two interventions both face different challenging situations during procedures with solutions given in the article. Post-operative statistics show that the complications of MRI-guided intervention are infrequent and mild, and MRI-guided biopsy provides the pathological information for the subsequent surgical decisions and MRI-guided localization fully prepared for follow-up surgical biopsy. New techniques for MRI-guided intervention are also elaborated in the article, which leads to future development. In a word, MRI-guided intervention is a safe, accurate, and effective technique with a low complication rate and successful MRI-guided intervention is truly teamwork with efforts from patients to surgeons, radiologists, MRI technologists, and nurses.
由于乳腺病变的高敏感性，磁共振成像（MRI）能够检测出在传统乳腺检查设备中隐匿的可疑病变。然而，MRI较低且变化不定的特异性使得在手术前进行MRI引导的干预（包括活检和定位）成为必要，特别是对于需要保乳手术（BCS）治疗的患者。在进行干预之前，应首先仔细考虑MRI技术和患者准备情况，以避免延长手术时间并影响靶向准确性。医生和放射科医生需要重新确认病变的靶点，并非常熟悉涉及计算机辅助诊断（CAD）工具和活检系统的操作方法和设备技术，并遵循正确的流程。无论供应商或平台如何，MRI引导活检和定位的基本步骤几乎相同，本文系统地介绍了MRI引导干预的详细方法和技术。这两种干预在操作过程中都面临不同的具有挑战性的情况，本文给出了解决方案。术后统计表明，MRI引导干预的并发症很少且轻微，MRI引导活检为后续手术决策提供病理信息，而MRI引导定位为后续手术活检做好充分准备。本文还阐述了MRI引导干预的新技术，这引领了未来的发展。总之，MRI引导干预是一种安全、准确且有效的技术，并发症发生率低，成功的MRI引导干预确实是患者、外科医生、放射科医生、MRI技术人员和护士共同努力的团队协作。
