ARRS 2022 Abstracts

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1445. A Systematic Review of Performance Benchmark Metrics and Clinicopathologic Outcomes of MRI-Guided Breast Biopsies
Authors * Denotes Presenting Author
  1. Justin Yan *; UT Southwestern Medical Center
  2. Serine Baydoun; Cleveland Clinic Breast Imaging
  3. Yin Xi; UT Southwestern Medical Center
  4. Marion Scoggins; MD Anderson Cancer Center
  5. Basak Dogan; UT Southwestern Medical Center
Objective:
Breast MRI-guided biopsy is a time-consuming and complex procedure that requires specific equipment and expertise. Current MRI-guided breast biopsy methods and subsequent clinicopathological outcomes may vary between institutions, hence there is a need to determine outcomes and benchmarks for institutional referencing.

Materials and Methods:
In this systematic review, we identified studies involving MRI-guided breast biopsies performed through April 2021 in Embase and Ovid MEDLINE databases (including "In Process" and "Other Non-indexed Citations") in accordance with PRISMA guidelines. Inclusion criteria included English language literature, availability of reported histopathological outcomes of benign, malignant, and high-risk lesions, and availability of final histopathology (gold standard) or 1-year imaging/clinical follow-up after biopsy. Odds ratios were pooled using a Bayesian bivariate hierarchical model.

Results:
Pooled reported data from 12 papers with a total of 7410 biopsies performed in 3167 patients was reviewed. Mean patient age was 50 years (95% CI: 48.34-53.11, SD: 3.22). Of the 7410 biopsies, 4511 were benign (60.88%, 95% CI: 52.86 - 68.89%, SD: 11.20%), 2121 were malignant [25.71%, 95% CI: 20.02-31.40%, SD:8.96%; invasive (11.90%, n = 882); DCIS (8.92%, n = 661); other (7.80%, n = 578)], and 778 were high risk (10.50%, 95% CI: 2.17-18.83%, SD: 9.01%). MRI indications were screening (29.0%, 95% CI: 15.88-42.24%, SD: 18.42%, n = 1051), history of breast cancer (15.6%, 95% CI: 3.74-27.50%, SD: 12.85%, n = 668), abnormal mammogram/ultrasound or clinical symptoms (8.65%, 95% CI: 0-17.75%, SD: 9.83%, n = 313), other (5.61%, 95% CI: 0-63.83%, SD:23.43%, n = 203), and unknown primary (0.50%, 95% CI: 0-3.87%, SD: 0.38%, n = 18). A median of 12 cores were obtained per biopsy [range 4-60]. The average success rate was 93.73% (95% CI: 86.72-100%, SD: 7.58%). Biopsy failure occurred in 246 [3.20%, 95% CI: 0-20.61%, SD: 10.94%]. Of MRI indications, history of breast cancer was significantly associated with malignant outcome [pooled OR 2.44, 95%CI: 0.91-5.67] followed by diagnostic [OR 1.25, 95%CI: 0.49-2.53], staging [OR 1.18 (95% CI: 0.50-2.48), and 0.77 (95%CI: 0.33-1.69) for screening. Surgical upgrade to invasive cancer occurred in 6.35% of pure DCIS (95% CI: 0-25.5%, SD: 12.06%, n = 42). and 23.58% of high-risk lesions (95% CI: 8.97-38.20%, SD: 5.88%, n = 54). Short-term follow up was performed in 1263 lesions (17%, 95% CI: 0-39.8%, SD: 18.38%). Rad-path discordance (0.8%, 95% CI: 0-1.76%, SD: 0.93%, n = 58), false negative results (0.2%, 95% CI: 0-0.54%, SD: 0.30%, n = 12) and biopsy complications [hematoma 2.14%, vasovagal response 0.41%,] were rare.

Conclusion:
MRI-guided needle biopsy is a highly accurate technique with negligible failure, false negative, and complication rates. Mean success and malignancy rates show little variation, and malignancy rates are higher for patients with a history of breast cancer. No imaging follow-up is needed for benign-concordant results.