Suman Laura, D'Ascoli Elisa, Depretto Catherine, Berenghi Alessandro, De Berardinis Claudia, Della Pepa Gianmarco, Irmici Giovanni, Ballerini Daniela, Bonanomi Alice, Ancona Eleonora, Scaperrotta Gianfranco Paride
Breast Radiology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori Di Milano, Via Giacomo Venezian 1, 20133, Milan, Italy.
Postgraduation School in Radiodiagnostics, Università Degli Studi di Milano, Milan, Italy.
Breast Cancer Res Treat. 2025 Apr;210(2):417-423. doi: 10.1007/s10549-024-07579-1. Epub 2024 Dec 18.
Magnetic resonance imaging (MRI)-guided vacuum-assisted breast biopsy (VABB) is an increasingly requested procedure, but it implies training and experience both in its execution and in determining radiological-pathological concordance and is therefore performed in dedicated breast centers. The purpose of this study is to evaluate the diagnostic performance of MRI-guided vacuum-assisted biopsy and to determine the upgrade rate after surgery or follow-up.
We retrospectively evaluated all consecutive patients with suspicious MRI findings without corresponding mammographic and ultrasonographic findings who underwent MRI-guided vacuum-assisted breast biopsy (VABB) at our Institution from November 2020 to March 2023. We determined the sensitivity (SE), specificity (SP), positive predictive value (PPV), negative predictive value (NPV) and accuracy of the procedure; we also assessed upgrade rate to malignancies using surgery or at least 1-year negative follow-up as reference standard. Fisher's exact test was used to evaluate the correlation between enhancement size and type (mass/non-mass) and histological outcomes.
A total of 121 patients with 122 suspicious breast lesions have been included. 29.5% (n = 36) of these lesions were classified as malignant (B5), 23% (n = 28) were lesions with uncertain malignant potential (B3 lesions), and 47.5% (n =58) were benign (B2). Among B5 lesions, 47.22% (n =17) were ductal carcinomas in situ (DCIS) and 52.77% (n = 19) were invasive carcinomas. Among patients with already diagnosed breast cancer (n = 36), MRI-guided VABB identified additional foci of disease in 36.1% (n = 13) of the cases, specifically 10 foci on the same breast and 3 in the contralateral breast. Accuracy of MRI-guided VABB was 96.7%, SE was 90%, SP was 100%, PPV was 100%, and NPV was 95.3%. 4 benign lesions (B2 and B3) were upgraded to B5 lesions after surgery or follow-up; the upgrade rate to malignancies was 3.28%. Fisher's exact test showed a significant association between enhancement size and histological outcomes (OR = 2.38, p = 0.046), while enhancement type was not significantly correlated (OR = 0.88, p = 0.841). No major complications have been reported.
MRI-guided VABB has proven to be a mini-invasive, safe, and accurate procedure for the diagnostic work-up of suspected breast lesions, which can help in the management of patients aiding in the correct surgical decisional process.
磁共振成像（MRI）引导下的真空辅助乳腺活检（VABB）是一种需求日益增加的检查方法，但它在操作以及确定放射学-病理学一致性方面都需要培训和经验，因此通常在专门的乳腺中心进行。本研究的目的是评估MRI引导下真空辅助活检的诊断性能，并确定手术或随访后的升级率。
我们回顾性评估了2020年11月至2023年3月期间在我院接受MRI引导下真空辅助乳腺活检（VABB）的所有连续患者，这些患者有可疑的MRI表现但无相应的乳腺X线摄影和超声检查结果。我们确定了该检查方法的敏感性（SE）、特异性（SP）、阳性预测值（PPV）、阴性预测值（NPV）和准确性；我们还以手术或至少1年的阴性随访作为参考标准，评估了恶性肿瘤的升级率。采用Fisher精确检验评估强化大小和类型（肿块/非肿块）与组织学结果之间的相关性。
共纳入121例患者的122个可疑乳腺病变。其中29.5%（n = 36）的病变被分类为恶性（B5），23%（n = 28）为恶性潜能不确定的病变（B3病变），47.5%（n = 58）为良性（B2）。在B5病变中，47.22%（n = 17）为导管原位癌（DCIS），52.77%（n = 19）为浸润性癌。在已诊断为乳腺癌的患者（n = 36）中，MRI引导下的VABB在36.1%（n = 13）的病例中发现了额外的病灶，具体为同一侧乳腺10个病灶，对侧乳腺3个病灶。MRI引导下VABB的准确性为96.7%，SE为90%，SP为100%，PPV为100%，NPV为95.3%。4个良性病变（B2和B3）在手术或随访后升级为B5病变；恶性肿瘤的升级率为3.28%。Fisher精确检验显示强化大小与组织学结果之间存在显著关联（OR = 2.38，p = 0.046），而强化类型无显著相关性（OR = 0.88，p = 0.841）。未报告重大并发症。
MRI引导下的VABB已被证明是一种用于可疑乳腺病变诊断检查的微创、安全且准确的方法，有助于患者的管理，辅助正确的手术决策过程。
