Contributor Name: Prof. Dr. Sylvia H. Heywang-Köbrunner

Hospital: Martin-Luther University Halle-Wittenberg, Halle

Patient History

57 year old patient with family history (Both mother & sister) of postmenopausal breast cancer.Clinical examination was normal. Mammography revealed dense breast without suspicious findings. Ultrasound examination was defined as in normal range.

Image Findings

Bilateral mammogram Craniocaudal & Lateral oblique views showing dense breasts.

A nodular enhancing lesion is seen
in breast MR images. Since the lesion
was not visible with any other method,
even in retrospect, the patient was
referred for MR-guided biopsy.

For the biopsy the patient is positioned prone.
The breast in question is moderately compressed
and thus fixed in the biopsy device.

Precontrast, postcontrast and subtraction image of the slice in question, imaged while the breast was fixed in the biopsy device.

By clicking a zero marker and the center of the lesion, the coordinates for needle insertion are calculated for various angles (0, 15, 30). In this case a 15° angle was chosen and an MR compatible substitute needle was introduced outside the bore.

This image shows correct placement of the substitute angle. (The lesion is pierced by the needle and the needle exceeds the center of the lesion by another 18 mm)

After correct needle placement was confirmed, the patient is moved out of the bore. The transverse slice containing the lesion is aligned with the aiming device; the substitute needle is exchanged again with the vacuum biopsy needle (which is mounted in the corresponding gun on the aiming device) and the vacuum biopsy is performed.

Correct excision can be checked immediately after vacuum biopsy. Another possibility is to control one or several days later by acquiring 3D data set of images before and after injection of MR contrast agent. (0.15 mmol Gd-DTPA/kg bw)

Precontrast, postcontrast and subtraction images confirm removal of the enhancing lesion (the cavity collapsed), which proved to be a 1cm invasive ductal carcinoma.

Results and Discussion

Histologic evaluation of the excised tissue proved to be a 1cm invasive ductal carcinoma.

Customer Testimonial from Prof. Dr. Sylvia H. Heywang-Köbrunner Martin-Luther University Halle-Wittenberg, Halle, Germany

The MR breast biopsy device, offered by Siemens Medical Solutions, is until now the only approved device which offers the following features:

Approach to the breast laterally and medially. This feature is highly appreciated by surgeons. Wire localization with the shortest possible access supports the surgeon's choice of an optimal cosmetic approach. Both, wire localization and percutaneous biopsy using such an access allow unproblematic oncosurgical planning and excise of the needle path in case of malignancy.

- Optimized approach to practically all areas of the breast - by using compression plate with flexible bars - by allowing a software supported access to the lesion at various angles.

- Possibility for adapting and supporting any needle type or biopsy gun including the unique possibility of vacuum biopsy.

Vacuum biopsy offers the following important advantages over core needle biopsy or FNA:

- Compensation for tissue shift due to needle insertion, local anesthetic or bleeding, by use of vacuum suction and acquisition of sufficient tissue (approx. 10g).

- Avoidance of sampling errors

- Excellent confirmation of representative biopsy by subsequent excellent visualization of complete or partial excisions of the entire area in approximately 90% of all cases.

The biopsy device has undergone extensive optimization and testing in a European multicenter study in five centers on > 200 MR-guided wire localization and > 400 MR-guided vacuum biopsies. The study was supported by the European Commission in the Biomed 2 project BMH4-CT-374.

Publications

Heywang-Köbrunner SH, Heinig A, Schaumlöffel-Schulze U, Viehweg P, Buchmann J, Lampe D, Spielmann RP. MR-guided percutaneous excisional and incisional biopsy (PEIB) of breast lesions. Europ Radiol 1999; 9: 1656-1665

Prat X, Sittek H, Grosse A, Baath L, Perlet C, Alberich T, Lamarque JM, Andersson I, Reiser M, Fischer H, Heywang-Köbrunner SH. European Quadricentric evaluation of a breast MR biopsy and localisation device: technical improvements based on phase I evaluation. Eur Radiology 2001, preliminary accepted

Perlet C, Heinig A, Prat X, Baath L, Sittek H, Stets C, Lamarque JM, Andersson I, Schneider P, Taourel P, Reiser M, Heywang-Köbrunner SH. Multicenter study for the evaluation of a dedicated localisation and biopsy device for MR-guided intervention: preliminary results after 18 months, Eur Radiology preliminary accepted

Perlet C, Schneider P, Amaya B, Grosse A, Sittek H, Reiser M, Heywang-Köbrunner SH. MR-geführte Vakuumbiopsie bei kontrastmittelanreichernden Läsionen der Mamma an 228 Patientinnen: Ergebnisse zweier Zentren. preliminary accepted

Lampe D, Hefler L, Alberich T, Sittek H, Perlet C, Prat X, Amaya B, Koelbl H, Heywang-Köbrunner SH. The clinical value of preoperative wire localization of breast lesions by magnetic resonance imaging - a multicenter study. preliminary accepted