title: MRI-guided breast biopsy: outcomes and effect on patient management.
abstract: BACKGROUND
  The purpose of this study was to correlate the pathology results of MRI-guided breast biopsies at our institution with MRI findings and patient clinical history characteristics. The effect of MRI-guided breast biopsies on surgical management in patients with a new diagnosis of breast cancer was also assessed.
  
  
  METHODS
  In this Health Insurance Portability and Accountability Act-compliant study we retrospectively reviewed all MRI-guided breast biopsies performed from March 2006 to May 2012. Clinical history, MRI features, and pathology outcomes were reviewed. In patients who underwent breast MRI to evaluate extent of disease, any change in surgical management resulting from the MRI-guided biopsy was recorded. Statistical analysis included binary logistic regression and independent Student t test.
  
  
  RESULTS
  Two-hundred fifteen lesions in 168 patients were included, of which 23 (10.7%) were malignant, 43 (20%) were high-risk, and 149 (69.3%) were benign. No clinical characteristic was associated with malignancy in our cohort. MRI features associated with malignancy were: larger size (mean 2.6 cm vs. 1.3 cm; P = .046), washout kinetics (18% malignancy rate; P = .02), and marked background parenchymal enhancement (40% malignancy rate; P < .001-.03). Nineteen (28%) of the 67 patients with a new diagnosis of breast cancer who underwent MRI-guided breast biopsy had a change in surgical management based on the biopsy result.
  
  
  CONCLUSIONS
  Malignancy rate was associated with lesion size, washout kinetics, and marked background enhancement of the breast parenchyma but was not associated with any clinical history characteristics. Preoperative MRI-guided breast biopsies changed surgical management in 28% of women with a new diagnosis of breast cancer.
authors.affiliation: Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, Baltimore, MD. Electronic address: myersk@mskcc.org.
authors.forename: Kelly S
authors.initials: KS
authors.lastname: Myers
authors.affiliation: Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, Baltimore, MD.
authors.forename: Ihab R
authors.initials: IR
authors.lastname: Kamel
authors.affiliation: Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, Baltimore, MD.
authors.forename: Katarzyna J
authors.initials: KJ
authors.lastname: Macura
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery*; D019468:Disease Management; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
keywords: Breast MRI; Core biopsy; MRI-guided biopsy; Pre-operative breast MRI