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  • Title: Outcomes of Preoperative MRI-Guided Needle Localization of Nonpalpable Mammographically Occult Breast Lesions.
    Author: Gao Y, Bagadiya NR, Jardon ML, Heller SL, Melsaether AN, Toth HB, Moy L.
    Journal: AJR Am J Roentgenol; 2016 Sep; 207(3):676-84. PubMed ID: 27275652.
    Abstract:
    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. MATERIALS AND 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. CONCLUSION: 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.
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