MRI-guided Needle Localization for Breast Lesions Occult in Mammograms and Ultrasound

以乳房磁振造影指引之細針定位術化驗乳房攝影及乳房超音波無異常之病灶

王薏婷(Yi-Ting Wang) ； 黃俊升(Chiun-Sheng Huang) ； 李曉彤(Hsiao-Tung Lee) ； 張允中(Yeun-Chung Chang) ； 廖漢文(Hon-Man Liu)

《中華放射線醫學雜誌》 33卷1期 (2008/03) Pp. 1-7

摘要

評估對於在理學檢查、乳房攝影及乳房超音波檢查皆無異狀，但在乳房磁振造影(MRI)檢查上卻有懷疑的病灶，使用乳房磁振造影指引之細針定位及手術切片化驗的準確性與可行性。
總共有12位病灶只能被乳房磁振造影所偵測到的病人（年齡29~68歲；44.9±9.24歲）成功地接受乳房磁振造影指引之細針定位及手術切片，過程皆使用1.5T MRI機器、乳房切片專用的配備及與MRI相容之定位細針。其中11位病人由外側入針，1位由內側入針，在置放定位細針之前及之後，皆注射顯影劑以確認正確位置。
病灶大小為0.6~5公分（1.44±1.29公分）。其中，2例(16.7%)為原位癌，3例(25%)為癌前或高危險病灶，包含一例lobular carcinoma in situ合併atypical ductal hyperplasia(ADH)、一例atypical lobular hyperplasia合併乳突瘤、及一例ADH，7例(58.3%)為良性病灶。此12例定位檢查，並無造成任何併發症。
對於在乳房攝影及乳房超音波檢查下無異狀，但乳房磁振造影(MRI)上卻有懷疑的病灶，乳房磁振造影指引之細針定位提供－安全、迅速、準確的切片化驗方式。

並列摘要

To evaluate the diagnostic efficacy of breast magnetic resonance imaging (MRI)-guided needle localization and surgical biopsy for suspicious breast lesions occult on physical breast examination, mammography and second-look ultrasound.
Twelve patients (age range, 29-68 years; mean 44.9±9.24 years) received breast MR-guided needle localization and surgical biopsy for the suspicious lesions detected by breast MRI only. All procedures were successfully performed in a 1.5T MR system equipped with dedicated breast biopsy system. Eleven of the patients received lateral approach and one received medial approach with a 20-gauge MR-compatible localization needle. Contrast enhancement was given before or after deployment of the hookwire to confirm the location of the hookwire and the suspicious breast lesion.
The size of breast lesions ranged from 0.6 to 5 cm (mean±SD, 1.44±1.29cm). Final pathologic diagnoses from surgical specimens included two low grade ductal carcinoma in situ (16.7%). There were three lesions (25%) diagnosed as pre-malignant or high risk lesions, including 1 lobular carcinoma in situ (LCIS) and atypical ductal hyperplasia (ADH), 1 atypical lobular hyperplasia (ALH) and papilloma, and 1 ADH. Seven lesions (58.3%) were benign fibrocystic change (n=5), fibroadenomatous change (n=1) and an intraductal papilloma (n=1). There was no procedurerelated complication. No definite abnormality was found in specimen mammograms in seven patients.
MRI-guided needle localization of breast lesions provides a confident approach for suspicious lesions detected only on MRI which cannot be biopsied under ultrasound or mammography guidance.