MRI-Guided Breast Biopsy
What Is an MRI-Guided Biopsy of the Breast?
Your physician may order an MRI for a more detailed look at breast tissues 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, as a supplemental imaging scan in addition to mammograms.
A breast MRI can evaluate the extent of disease in patients with a recent breast cancer diagnosis. Contrast MRI imaging looks for additional breast cancers within either breast. It can also provide a detailed map for surgeons before surgery.
Radiologists specializing 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. The radiologist will recommend a biopsy if the test shows a suspicious MRI lesion.
How Do Breast Abnormalities Appear on an MRI?
MRI, magnetic resonance imaging, uses magnets and radio waves to produce detailed 3D imaging of the breast or other organs. A breast MRI helps to distinguish normal tissues from abnormal tissue. Signs that may indicate breast tissue changes can include:
Masses
Lumps
Calcifications
Abnormal tissue
We use contrast to show blood vessels and help identify any potentially cancerous breast tissue, which needs a blood supply 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.
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. Some patterns of enhancement in the breast are normal, while others may represent breast cancer. The background parenchymal enhancement (PBE) refers to the qualitative enhancement of fibro glandular tissue. A subtle MRI abnormality will be less evident in a breast with 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 contrast 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. We describe the enhancing lesion using the American College of Radiology lexicon called the Breast Imaging Reporting and Data System, or BI-RADS. A rapidly enhancing irregular mass with rapid washout is more suspicious than a progressively enhancing oval mass with plateau kinetics.
Who’s Reading Your MRI?
What to Expect With an MRI-Guided Breast Biopsy
The breast MRI biopsy will be scheduled for a different day than your original MRI because the radiologist needs time to review multiple images and sequences. In addition, your insurance plan may need to authorize the procedure. MRI imaging and biopsy together take about 45 minutes. Please allow an hour if needed.
Meet Our Specialists
Frequently Asked Questions About MRI-Guided Breast Biopsy
An MRI-guided breast biopsy is a minimally invasive procedure that uses MRI technology to guide the biopsy needle to obtain tissue samples from suspicious areas in the breast. The radiologist removes small tissue samples to be sent off for testing.
If a patient has breast implants, we can use a special technique to safely perform the biopsy without damaging the implant. Typically, this involves using a needle that is longer than normal to reach the tissue sample through the implant.
Studies have shown that the cancer detection rate with MRI-guided biopsy ranges from 10-50%.
The main difference between an MRI-guided breast biopsy and a breast stereotactic biopsy is the type of imaging used to guide the procedure. MRI-guided biopsy uses MRI technology to locate the suspicious area, while stereotactic biopsy uses mammography or X-ray imaging. Both biopsies are minimally invasive procedures used to obtain tissue samples from the breast for further analysis.
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 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 lie 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.
Yes, we recommend that you talk with your insurance provider before your MRI or MRI-Guided biopsy is scheduled to determine your financial responsibility 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 your insurance plan authorizes the exam, that doesn’t mean they will fully pay for the exam or biopsy. This depends on your deductible and your particular plan.
The Women’s Imaging Center has 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 can also pay 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 hospital charges or facility step-up fees, and therefore lower cost. We work hard to ensure that women have access to imaging services they need without cost being a barrier.
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