57 year-old female with known DCIS in the left breast. Outside MRI demonstrated an indeterminate enhancing mass posterior to the proven DCIS. MRI guided biopsy for the indeterminate enhancing mass is performed. On subtraction images, a linear non-mass enhancement (15 mm in AP dimension) is demonstrated posteriorly extending from the known DCIS lesion. The enhancing mass seen on the outside MRI likely corresponds to the posterior portion of this non-mass enhancement. Therefore, it is determined to biopsy the most posterior portion of this non-mass enhancement. PROCEDURE:Coordinates of the central portion of the biopsy target were determined on the monitor. The approach was from lateral to medial direction. Overlying skin was cleansed with chlorhexidine and superficial and deep anesthesia were obtained with lidocaine. A 9-gauge introducer with stylet was advanced to the target lesion. Subsequent MR images confirmed satisfactory position of the tip of the introducer prior to the biopsy. A 9-gauge needle was then advanced to the target lesion and biopsy was performed using a Suros vacuum assisted device. A total of 10 cores were obtained and they were sent to Pathology with an accompanying history sheet.Post procedural MR images show a small hematoma at the biopsy site. An ATEC clip was placed to the target.Per a recommendation at the breast conference, a Hydromark clip was placed to the most posterior margin of the main enhancing lesion, in case this biopsy results are benign and a bracketed needle localization for main DCIS has to be planned.Following the removal of the grid, pressure was held at the biopsy site until bleeding subsided. The skin wound was closed with a Steri-Strip and pressure bandage and ice pack were applied to the biopsy site.Specimen radiograph was obtained for documentation. No calcifications were seen in the specimen radiograph.The patient tolerated this procedure well and underwent a left unilateral digital mammogram CC and ML views to locate the percutaneously placed clip. The clip is placed at posterior upper outer quadrant, with no evidence of any complications due to the procedure. The marker clip for the biopsy site is located 20 mm posterior from a clip of the known DCIS, and 8 mm posterior to the Hydromark clip for the posterior margin of the DCIS. Distance between the clip for known DCIS placed outside institution and the clip for the posterior margin of the DCIS is 15 mm. The patient tolerated this procedure well and left the radiology suite in stable condition. The MR procedure was performed by Dr. Abe.
Successful MR guided core needle biopsy of the left breast, posterior non mass enhancement from the main DCIS. Successful clip placement for the biopsy site and the posterior margin of the main DCIS lesion. Pathology is pending.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.