MRI Follow-Up May Not Be Necessary Following Breast MRI-Guided Vacuum-Assisted Biopsy

Breast MRI–guided vacuum-assisted biopsy (VAB) has a low false omission rate, and MRI follow-up of lesions with concordant benign MRI-guided VAB histopathology results may not be warranted, according to a study published in the American Journal of Roentgenology.  Researchers from the University of Texas MD Anderson Cancer Center in Houston and the University of Texas Southwestern Medical Center in Dallas performed a study to determine the false omission rate of breast MRI–guided VAB with benign histopathology to assess whether breast MRI follow-up is needed. The researchers retrospectively reviewed the records of patients who had undergone 9-gauge breast MRI–guided VAB during 2007 to 2012. Lesions with imaging-concordant benign histopathology results from MRI-guided VAB and surgery or two years or more of imaging follow-up were included. They, then, calculated the false omission rate (1 – negative predictive value; [number of false-negative results / number of negative results]) of the MRI-guided VAB of 169 lesions; 135 had only imaging follow-up: • Mammography follow-up with 17-to-107 months (median, 52 months)• MRI follow-up with 5-to-95 months (median, 35 months) Of these 135 lesions: 48 had mammography only within 26-to-86 months (median, 52 months)87 had mammography within 17-to-107 months (median, 52 months) and MRI  with 5-to-95 months (median, 35 months) The results showed that 34 lesions had surgical correlation and there were no cases of imaging-surgical discordance. Four malignancies were later diagnosed in the same breast in which MRI-guided VAB had been performed. One (0.6 percent) malignancy was invasive ductal carcinoma at 1 cm from the MRI-guided VAB site. This lesion was detected by mammography 24 months after MRI-guided VAB. The other three malignancies developed 4 cm or more from the site of MRI-guided VAB:  • One ductal carcinoma in situ (DCIS) detected on mammography 12 months after MRI-guided VAB • One DCIS detected on MRI 24 months after MRI-guided VAB• One Paget disease lesion detected at physical examination 32 months after MRI-guided VAB The researchers concluded breast MRI–guided VAB has a low false omission rate. MRI follow-up of lesions with concordant benign MRI-guided VAB histopathology results may not be warranted.