The obturator was identified on MRI as a low-signal focus measuring a median of 0.3 cm (range, 0.2–0.6 cm) in width. The depth (z-axis) coordinate of the lesion was determined on the basis of the relationship between the lesion and the skin surface. The depth of the lesion from the skin surface in millimeters (z) was calculated by determining the number of sagittal slices between the skin and the lesion and multiplying by 3 (to account for the 3-mm slice thickness). Although it remains controversial, excision may also be warranted for lesions yielding LCIS at percutaneous biopsy [35]. In women at high risk of developing breast cancer, MRI detects a cancer occult to mammography and physical examination in 2–8% [1]. The median size of these 27 lesions was 1.0 cm (range, 0.4–6.4 cm). The nipple, which enhanced at MRI, was excised without localization and yielded DCIS. We injected a generous wheal of anesthetic to increase breast thickness. The stylet was placed in the incision until the white plastic introducer entered the skin (to create the tract) and was then removed. Among these 27 lesions, quadrant location was upper outer quadrant in 11, lower outer quadrant in 11, upper inner quadrant in four, and lower inner quadrant in one. 1976. An ultrafast sequence provides early enhancement of lesion characteristics that optimize the characterization of the fast protocol, increasing positive predictive values without increasing time. Of 98 consecutive women who had MRI-guided needle localization during the study period, 27 were invited to participate in the study, and 20 agreed to be included. A leading journal selection tool is available free of charge for authors to find the best fit for their manuscript. 10.2214/AJR.18.20396 OBJECTIVE. In four (17%) of 24 lesions the radiologist noted that differentiating the clip from low-signal foci representing air was difficult, but could be accomplished by comparing images before and after clip placement. The American Journal of Gastroenterology. ... Official journal of the American Roentgen Ray Society, 1976- and the American Radium Society, 1976-1980. online access Those results represent the culmination of nearly two years of open research by FAIR and NYU Langone Health, which is a group of academic medical centers in New York City. We encountered some difficulties with clip deployment, with a second attempt necessary in almost one quarter of the cases. In one (4%) of the 27 lesions, a 5.0-cm non–mass lesion sampled at vacuum-assisted biopsy, vacuum-assisted biopsy histology revealed markedly atypical ductal hyperplasia and lobular carcinoma in situ (LCIS); surgical excision showed markedly atypical ductal hyperplasia focally reaching the level of low-grade cribriform DCIS, arising in a background of florid mammary sclerosing adenosis and columnar cell changes, as well as extensive LCIS (Fig. The results, published in the American Journal of Roentgenology, found no significant differences in the radiologists' evaluations. The results of the study ("Using Deep Learning to Accelerate Knee MRI at 3T: Results of an Interchangeability Study"), were published in the American Journal of Roentgenology. The study shows that fastMRI can generate “diagnostically interchangeable” MRI images of knee injuries while using about 75 percent less raw data from the … This procedure helped to ensure that the biopsy device entered through the incision site, even when that site was later obscured by the needle guide. Immobilizing the breast without excessive compression may be helpful during MRI-guided biopsy to maximize breast thickness, avoid interfering with lesion enhancement [28], and minimize the “accordion effect” described with clip placement [33]. Data were entered into a computerized spreadsheet (Excel, Microsoft, Redmond, WA) for analysis. Section Editor's Notebook: Women's Imaging—Problem Solving in Everyday Practice. Section thickness was between 2 and 3 mm without a gap using a matrix of 256 × 192 and a field of view of 18–22 cm. The depth of the skin surface from the outer aspect of the needle guide was 20 mm (because the needle guide was 2-cm thick). Total imaging time per breast, including three contrast-enhanced acquisitions, was approximately 20 min. OBJECTIVE. The American Journal of Roentgenology (AJR) is a monthly peer-reviewed journal that covers topics in radiology. The sixth cancer was a 0.7-cm mass in which the imaging target may have been excised at MRI-guided vacuum-assisted biopsy, and histologic analysis of vacuum-assisted biopsy specimens yielded infiltrating lobular carcinoma; the surgical specimen showed fibrosis and changes related to prior biopsy, with no residual carcinoma (Fig. Placing the device and imaging to confirm its location.—A mark was made on the skin overlying the lesion, and the skin was cleansed with alcohol and anesthetized with 3–8 mL of 1% lidocaine hydrochloride (Xylocaine [10 mg/mL], AstraZeneca, Wilmington, DE). The biopsy cavity may therefore be larger, and ensuring hemostasis is important. In one (4%) of the 27 lesions, a 0.4-cm smooth mass in a woman with Paget's disease of the nipple, MRI-guided vacuum-assisted biopsy yielded fibroadenoma and stromal fibrosis; MRI after vacuum-assisted biopsy showed that the MRI target may have been excised. 2020;214: 282-295. Informed consent, preparation before the biopsy, biopsy equipment, and radiologists.—Informed consent was obtained for all biopsy and needle localization procedures. Cancers diagnosed included multicentric, multifocal, or contralateral disease in women with proven cancer and cancers found at MRI screening of women at high risk for breast cancer. The clear obturator was then removed from the white introducer, and the sharp stylet was placed inside the white introducer as far as it could go (Fig. Postbiopsy collections of air (n = 5), fluid (n = 5), or both (n = 16) measuring a median of 1.9 cm (range, 0.6–3.2 cm) were observed on MRI in all lesions. Imaging-Based Approach to Axillary Lymph Node Staging and Sentinel Lymph Node Biopsy in Patients With Breast Cancer, Review. The American Journal of Roentgenology (AJR) is a monthly peer-reviewed journal that covers topics in radiology. Automated core biopsy requires that the needle traverse a lesion in order to sample it. The median time to perform vacuum-assisted biopsy of a single lesion was 35 min (mean, 35 min; range, 24–48 min). MRI-Guided 9-Gauge Vacuum-Assisted Breast Biopsy: Initial Clinical Experience, Clinical Experience with MRI-Guided Vacuum-Assisted Breast Biopsy, Original Research. The front end of the probe was placed back into the introducer. In this series, authors of select AJR articles discuss how their studies were performed, the results, and how the studies changed their practices. MRI sequences performed after completion of tissue acquisition were reviewed for 26 lesions; in one lesion these images were not available because of magnet malfunction. The protocol for this study was approved by our institutional review board. Predictors for Failing the American Board of Radiology Core Examination Gary Lloyd Horn , Stephen Herrmann , Irfan Masood , Clark R. Andersen , Quan Dang Nguyen American Journal of Roentgenology . MRI-guided vacuum-assisted breast biopsy, which has been successfully performed in more than 500 lesions in Europe [29], was recently approved for use in the United States. Because lesion conspicuity usually diminishes with time after contrast injection, sampling is dependent on identification of the lesion immediately after injection and immobilizing the lesion so that it remains in the same position. Among these 27 lesions, histology was benign at vacuum-assisted biopsy and at surgery in 19 lesions (70%) (Fig. Obtaining a two-view mammogram after biopsy is essential to assess location of the clip with respect to the biopsy cavity. 5A, 5B, 5C). After the biopsy device was placed, the time of each round of tissue acquisition was determined, in seconds, by calculating the interval between stepping on the foot pedal to begin to acquire tissue and releasing the foot pedal at the completion of tissue acquisition, including any interval injection of anesthesia. We also thank Charles Nyman and David C. Perlman for invaluable assistance. This time is faster than prior reports of MRI-guided needle biopsy: in the largest series to date, average time to perform biopsy was 60 min for MRI-guided fine-needle aspiration [11], 60 min for MRI-guided automated core biopsy [23], and 70 min for MRI-guided vacuum-assisted biopsy [28]. Was deployed by pushing down on the handle readily identified on MRI as a lesion was eight ( range 0.4–6.4... Helpful in this study is larger than the biopsy was technically successful in 25 ( %... David Dershaw 1, Elizabeth A. Morris 1, D. David Dershaw 1, Kimberly J injected a generous of. 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