MRI-Guided Breast Biopsy

What is an MRI-Guided Breast Biopsy? 

A Breast MRI may be ordered by your physician to get a more detailed look, either for prevention or diagnosis. Sometimes a breast MRI is performed as a preventative imaging scan in high-risk women with a strong family history of breast cancer. These women may undergo regular MRI imaging to look for subtle differences that may represent cancer. Mammograms are still considered the first line in breast imaging, and the MRI is a supplemental imaging scan.

A breast MRI is also used as a medical diagnostic imaging exam. It can evaluate the extent of disease in patients with a recent diagnosis of breast cancer. Contrast MRI imaging looks for additional breast cancers within either breast. This examination provides valuable information for the surgeon, giving her a more detailed map prior to any surgery. 

Radiologists specialized in Women’s Imaging look for subtle tissue changes in the breast including vascular changes found by breast MRI. 

These changes may be as obvious as a rapidly enhancing mass or as subtle as a non-mass-like enhancement. If a suspicious MRI lesion is discovered, the radiologist will recommend a biopsy. Sometimes, this biopsy can be performed 

 

What is a Breast MRI?  

Unlike a mammogram, which uses X-rays to create images of the breast or other parts of the body, Magnetic Resonance Imaging (MRI for short) technology uses magnets and radio waves to produce detailed 3-D Imaging of the breast or other organs. A breast MRI is performed to distinguish the normal tissues from abnormal tissue. 

Contrast is used to show blood vessels and help identify any potentially cancerous breast tissue. Cancers need a blood supply in order to grow. On a breast MRI, the contrast tends to become more concentrated in areas of cancer growth. These areas may show up as white areas on a dark background. 

 

How is a Breast MRI Performed? 

Before the MRI Scan is performed, it is important to prepare to answer a list of questions that will help The Women’s Imaging Center determine if you can have this imaging service. We will take a complete medical history of any medical conditions.  If there is any question about your kidney function, your ordering physician will order a blood test called “creatinine clearance” to see what your kidney function is. 

Before the MRI Imaging is performed, The Women’s Imaging Center will determine if this exam is the best one for you. We may inject a contrast dye (called Gadolinium) into a vein in your arm. The contrast is taken up differently in different types of tissues to different degrees. It is important to tell the scheduler AND the MRI technologist if you have ever had an allergic reaction to a contrast agent previously. The dye used in MRI is different from that used in a CT exam. For most people, this is not an issue. 

 

What if You are Claustrophobic? 

Claustrophobia, “a fear of being in closed or narrow spaces”, is not uncommon. The MRI used at The Women’s Imaging Center has an especially wide bore (opening), so much that you can barely touch the sides with your outstretched arms. The MRI machine is also shorter than most MRI machines you would see at hospitals since we perform dedicated MRIs of specific female systems like breasts, pelvis, and abdomen. The Espirit MRI is also called an “Open MRI Solution” by the manufacturer Siemens. You will be lying comfortably on your abdomen with your breasts gently suspended with the excess room. Your head will be near the end of the magnet so you can see out. Your forehead rests on a special pad like a massage table with a mirror so you can see all around you. You will be talking with the MRI technologist during the entire exam and she can make any adjustments to make you more comfortable. The great majority of the time, no premedication is needed. However, if you feel you simply cannot perform the MRI without sedation, then our physicians or yours can write oral anxiety medications that you will have to pick up and coordinate with the timing of your MRI exam under our advice. If you need to take these medications, you will need a driver, we are not permitted to let you drive yourself if you have taken any medications that may make you drowsy. 

Who Interprets The Breast MRI? 

A specialized radiologist with many years of training in Women’s Imaging and Breast Imaging interprets the MRI scan images to distinguish the different patterns of vascular uptake in the tissues called enhancement. The more experience the facility has for performing breast MRIs, the better the images are for interpretation. 

At The Women’s Imaging Center, we perform thousands of MRIs. Our radiologists are experts at interpreting breast MRI and performing MRI -guided breast biopsies. Radiologists at  The Women’s Imaging Center are specialized in the performance of any or all modalities that are utilized in Women’s Radiology including breast, gynecologic, abdominal, thyroid,  pelvic, and endocrine bone density. 

MRI findings are described and categorized by the American College of Radiology under a special lexicon called the Breast Imaging – Reporting and Data System, called BI-RADS for short. Some patterns of enhancement in the breast are normal while others may represent breast cancer. 

The Radiologist will comment on the reason for the examination, whether it is for an annual scan (screening) for strong family history of breast cancer or staging of breast cancer. The radiologist will describe the composition of the breast, whether the tissue is extremely dense or almost entirely fat. The background parenchymal enhancement (PBE) refers to the qualitative enhancement of fibro glandular tissue. A subtle MRI abnormality will be less obvious in a breast that has moderate background enhancement. In comparison, an abnormal finding will stand out better in a breast with minimal background enhancement. 

The rate of uptake and washout of the contract is called “kinetics”. Kinetics refers to the rate and pattern of contrast uptake of lesions in the breast. The kinetics do not tell the whole story. The enhancing lesion is described by a particular lexicon by the American College of Radiology called the Breast Imaging Reporting and Data System BI-RADS. A rapidly enhancing irregular mass with rapid washout is more suspicious than a progressively enhancing oval mass with plateau kinetics.  

If a suspicious finding on MRI is identified, an MRI-guided breast biopsy will be recommended. 

 

What Should I Do to Prepare Before the MRI Biopsy?

This breast MRI biopsy is scheduled for a different day than your original MRI because the radiologist needs time to review multiple images and sequences and because your insurance plan may need to authorize the procedure. 

We ask that you do not take medicines that can thin the blood unless you are directed to continue taking them by your referring physician. Some patients may have special reasons they need to stay on their blood thinners such as a clotting disorder. Always listen to your referring clinician regarding those decisions. We advise against taking aspirin if you are solely on it for prevention reasons. 

 

What Should I Expect on the Day of the Procedure? 

Your technologist will place a small catheter called an IV in the vein of your arm. You will be lying comfortably on your abdomen with your breasts gently suspended with the excess room. Your head will be near the end of the magnet so you can see out. Your forehead rests on a special pad like a massage table with a mirror so you can see all around you. The MRI we use is a large bore opening, also called an “Open Solution MRI”. The technologist will inject the contrast while you lie comfortably. 

You may feel a warm sensation for a few seconds during the injection. The magnet makes a loud clunk sound so the technologists will fit you with comfortable headphones and you may choose to listen to music through the headphone that makes the magnet sound indistinct. Many patients actually find the exam soothing because of the music and may fall asleep. It is important not to move quickly or jerk during the exam because this may cause irregularities in the images constituted from signals of the magnets. 

Like all of our procedures, you will see several assistants to help with the procedure- the Technologist, the Radiologist, and a Patient Navigator. 

The technologist will obtain MRI images for targeting, ad contrast dye will be injected to show the lesion. The radiologist will anesthetize the skin with a tiny numbing needle and use MRI Guidance to see exactly where the abnormality is located in 3D space. Another special needle called a “probe” is then inserted at the target site, more anesthetic is given through that probe, and a light vacuum is directed to the lesion. A Clip is placed at the biopsy site so that we know exactly where the tissue sample came from. The sample is then delivered to the Pathologist. The MRI imaging and biopsy together take about 45 minutes. Please allow an hour if needed. 

 

What Should I Expect After the Biopsy? 

We ask that you refrain from any rigorous activities for one to two days after the procedure. If you are planning an active vacation to include swimming or rigorous activities, you may want to postpone the biopsy until you return. Even though there will be only a tiny nick on the skin, we want to minimize the chance of soreness, infection, or bleeding at the site.  

You will likely experience slight bruising of the breast for a few days. Some women may complain of feeling a lump under the biopsy site for up to a week. 

When we take a tissue sample containing the calcifications out of the breast at a particular site, the body sends serum and blood to that area naturally. 

Infection is extremely rare, but if you have any redness at the site, any fevers or chills, we ask that you call us or return to The Women’s Imaging Center for evaluation. Direct contact sensitivity from the tape on the skin can be common in some people. A tape sensitivity is associated with a geographic shaped area that fits the line of the tape perfectly. So if the tape is itchy or burning, remove it and wear a tight sports bra instead. Call us or your referring clinician if you have any concerns at any time.  

 

How do I Obtain My MRI Biopsy Results? 

Results are available in 1-2 working days after the MRI biopsy. The Women’s Imaging Center Technologist, Radiologist, and Patient Navigator coordinate any follow-up care or management indicated. Follow-up imaging after biopsy may be recommended, even for benign biopsies. If the biopsy proves to be cancer, then your care Team at The Women’s Imaging Center will help navigate you through the treatment planning process. We will work with your referring clinician to coordinate an individualized treatment plan to fit your particular needs. 

 

Do I Need to Talk to My Insurance Provider about My Insurance Coverage Ahead of Time? 

Yes, we do recommend that you talk with your insurance provider before your MRI or MRI-Guided biopsy is scheduled to determine what your financial responsibility will be with them based on your particular insurance plan. We will also talk with an authorizing partner of your insurance company to determine if authorization is indicated. Even if the exam is authorized by your insurance plan, that doesn’t mean that the exam or biopsy will be fully paid for by them. This depends on your deductible and your particular plan.

At The Women’s Imaging Center, we have specialist staff dedicated to requesting this authorization from your insurance. If the insurance declines to authorize an exam, you have the right to contest this with an advocate at your insurance company. Remember, that you also have the option of paying out of pocket for any of your imaging exams here at The Women’s Imaging Center. All imaging studies at The Women’s Imaging Center are outpatient, independent of any hospital charges or facility step-up fees, and therefore lower cost. We bill globally which means that the price you are quoted is the final cost, with no hidden added-on fees.