Management of Breast Lesions Detectable Only on MRI

Abstract

Breast MR imaging has become established as the most sensitive imaging method for diagnosing breast cancer. As a result of the increasing examination volume and improved image quality, the number of breast lesions detected only on MRI and requiring further clarification has risen in recent years. According to the S3-guideline “Diagnosis, Therapy, and Follow-Up of Breast Cancer” as revised in July 2012, institutions performing breast MRI should provide the option of an MRI-guided intervention for clarification. This review describes the indications, methods and results of MRI-guided interventions for the clarification of breast lesions only visible on MRI. Recent guidelines and study results are also addressed and alternative methods and pitfalls are presented.

Key points:

• Up to 57 % of lesions originally visible only on MRI can be sonographically correlated and biopsied.

• MRI-guided intervention is necessary for the clarification of BI-RADS^® 4 and 5 lesions detectable only on MRI

• MRI-guided vacuum-assisted breast biopsy should be preferentially used

• MRI-guided localization and surgical excision should be used if MRI-guided vacuum-assisted biopsy is not possible

• If BI-RADS^® 4 and 5 findings visible only on MRI are not detectable on interventional MRI, a follow-up MRI should be performed within six months

Citation Format:

• Siegmann-Luz KC, Bahrs SD, Preibsch H et al. Management of Breast Lesions Detectable Only on MRI. Fortschr Röntgenstr 2014; 186: 30 – 36

Zusammenfassung

Die Mamma-MRT (Magnetresonanztomografie) hat sich als sensitivste bildgebende Methode in der Senologie etabliert. Durch steigende Untersuchungszahlen und verbesserte Bildqualität ist in den letzten Jahren ein Anstieg von abklärungsbedürftigen, ausschließlich MRT-detektierten Mammaläsionen zu verzeichnen. Die im Juli 2012 aktualisierte S3-Leitlinie „Diagnostik, Therapie und Nachsorge des Mammakarzinoms“ empfiehlt, dass alle Institute, die diagnostische MR-Mammografien durchführen, die Möglichkeit zur MRT-gestützten interventionellen Abklärung vorhalten sollen. Die vorliegende Übersicht beschreibt Indikationen, Methoden und Ergebnisse MRT-gestützter Interventionen zur Abklärung ausschließlich MRT-sichtbarer Mammaläsionen. Dabei werden aktuelle Leitlinien und Studienergebnisse berücksichtigt und alternative Abklärungsmethoden und Pitfalls aufgezeigt.

Key words

breast - MR imaging - interventional MRI

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