MRI-Guided Breast Biopsy Provides Patients Peace Of Mind

When Fay Ivey of Brandon was diagnosed with breast cancer in March and told she needed to schedule a mastectomy as quickly as possible, she experienced a wide range of emotions: apprehension, anxiety and fear of the unknown.

That fear was compounded when her mammogram revealed calcium deposits in her other breast. With a mastectomy already scheduled in April, Ivey was faced with the possibility of having to undergo two surgical procedures if the second lesion proved cancerous as well.

To address her concerns as quickly as possible, Dr. Amy Coleman, UMC assistant professor of radiology, turned to the Medical Center’s latest tool for breast cancer detection: magnetic resonance imaging (MRI) followed by an MRI-guided breast biopsy.

“We wanted to get complete information for both breasts before her scheduled surgery so she could go to surgery just one time,” Coleman said. “Now the patient and the surgeon can confidently know what the situation is before surgery. If we hadn’t looked, we might not have found the second area.”

Ivey was the first to have the MRI-guided biopsy at the Medical Center. A tissue sample was necessary to determine whether there was any cancer present in her second breast. Coleman used the Invivo DynaCAD system to first evaluate MRI images of the area and to guide the biopsy needle during the minimally invasive needle biopsy procedure.

"I was scared to death in the beginning,” Ivey recalled just minutes after the biopsy, “but I’d had an MRI before. I knew what that was like.

“The biopsy didn’t hurt at all. Pricking your finger at a doctor’s office (to give a blood sample) hurts worse than this did. If it can save me from having to have additional surgery, it was worth it.”

The procedure, which is conducted in the Medical Center’s MRI Department at the Jackson Medical Mall Thad Cochran Center, takes approximately 45 minutes. A special coil is placed around the patient’s breast while she lies completely still inside the MRI tube. The chest is scanned in a powerful magnetic field with radiofrequency signals while computer software translates the information onscreen. Radiologists view the display to pinpoint the optimum placement of the biopsy needle to obtain the needed sample with minimal scarring.

“This software helps draw your eye to the areas that are important,” Coleman said. “We can see the shape of the masses, the blood-flow pattern and the enhancement curve. This gives you a whole new set of tools for a different level of analysis.”

Although the system can detect tiny cancers that may not be obvious on mammograms or ultrasound studies and can detect cancer in dense breast tissue, breast MRI and MRI-guided breast biopsies shouldn’t be used “carte blanche” on all patients because of its extreme sensitivity, according to Dr. Heather C. Bracey, UMC instructor in radiology. 

“The MRI is becoming standard across the country for the staging of a known breast cancer and screening of the opposite breast for a mammographically occult malignancy,” said Bracey, who is completing a fellowship in breast imaging. “This is a wonderful diagnostic tool for patients who have a known preoperative primary breast cancer, who have a strong family history of breast cancer, who are known BRCA1- or BRCA2-positive patients, or who have implant complications.

“This is only recommended as an additional study after a mammogram. You would never do a breast MRI first. It is a test used in very specific circumstances, and if a suspicious area is identified, a biopsy using MRI guidance can be done."

“No other type of imaging shows calcifications like the mammogram,” Coleman said, although she said the new MRI software enhances image analysis with three-dimensional images of the breast. “This does add post-processing information and lets you manipulate the images for a better view of the important areas. But this is more of a problem-solving tool. Not everyone needs to line up for one of these.”

But for high-risk patients like Ivey, the new MRI-guided breast biopsy can offer some peace of mind that her cancer has been accurately identified and the proper treatment has been selected.

“I feel like this may have saved me from having to go through another surgery again,” she said.

— Bruce Coleman (4-16-07)

2007-04-16 00:00:00 3160