Outcomes of Preoperative MRI-Guided Needle Localization of Nonpalpable Mammographically Occult Breast Lesions.
OBJECTIVE
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
1 Department of Radiology, New York University Langone Medical Center, 160 E 34th St, New York, NY 10016.
Yiming
Y
Gao
1 Department of Radiology, New York University Langone Medical Center, 160 E 34th St, New York, NY 10016.
Neeti R
NR
Bagadiya
1 Department of Radiology, New York University Langone Medical Center, 160 E 34th St, New York, NY 10016.
Meghan L
ML
Jardon
1 Department of Radiology, New York University Langone Medical Center, 160 E 34th St, New York, NY 10016.
Samantha L
SL
Heller
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.
Amy N
AN
Melsaether
1 Department of Radiology, New York University Langone Medical Center, 160 E 34th St, New York, NY 10016.
Hildegard B
HB
Toth
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.
Linda
L
Moy
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle / Q000379:methods*; D001943:Breast Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008327:Mammography; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies
MRI-guided needle localization; MRI-guided procedures; breast MRI; breast conservation therapy; breast excision; enhancing foci; foci; lumpectomy; multicentric breast cancer; multifocal breast cancer; needle localization; needle localized excision biopsy