Simple MR Guided Breast Biopsy Strategy: technique and radiological-pathological association

doi:10.21203/rs.3.rs-4719861/v1

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Research Article

Simple MR Guided Breast Biopsy Strategy: technique and radiological-pathological association

https://doi.org/10.21203/rs.3.rs-4719861/v1

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Background

MRI is pivotal in breast imaging, encompassing staging, treatment monitoring, and lesion differentiation. While MRI boasts high sensitivity, specificity, and utility in detecting otherwise unseen lesions, challenges persist in accurately distinguishing benign from malignant findings. The study delves into MRI-guided breast biopsy outcomes and highlights the importance of radiologic-pathologic results.

Methods

This retrospective study analyzed 109 MRI-guided breast biopsies conducted on lesions identified between 2017 and 2023. the patients underwent biopsies for screening and diagnostic purposes. Biopsy procedures involved meticulous MRI guidance using a 1.5 Tesla system. Lesions were categorized based on location and BIRADS lexicon, with biopsy results spanning benign, suspicious, and malignant pathologies. Data collection encompassed a wide array of patient factors and pathology reports, meticulously reviewed by experienced radiologists, shedding light on the efficacy and outcomes of MRI-guided breast biopsies.

Results

The participants had a mean age of 45 ± 11 years. A significant association was found between the history of pregnancy and breast lesion enhancement. Patients with mass enhancement had a higher BIRADS B4b, B4c, and B5 classification rate, while those with non-mass enhancement were more commonly classified as BIRADS B3 and B4a. Histopathology diagnoses were significant in determining the presence of mass or non-mass lesions. The sensitivity and specificity of MRI for detecting malignancy were high for BIRADS categories 4c and 5 but may result in a higher number of false positives.

Conclusions

our research highlighted the significance of MRI in the diagnosis of breast cancer, particularly when used in conjunction with high-risk lesions as well as showed the need of sub-classifying BI-RADS-4 lesions to minimize the number of unnecessary biopsies. The results affirm the ongoing use of MRI-guided biopsy for the detection of breast cancer.

MRI-guided breast biopsies

BIRADS

Breast pathologies

Magnetic resonance imaging (MRI) has an important role in breast imaging for various clinical purposes. These include preoperative staging, monitoring the response to neoadjuvant chemotherapy, differentiating scar tissue from recurrence, assessing breast implants, evaluating patients with cancer of unknown primary origin, and screening high-risk individuals (1, 2). When suspicious lesions are identified using mammography, digital breast tomosynthesis, or sonography, MRI may provide additional non-invasive data for decision-making (3, 4). MRI can detect lesions that are not visible in ultrasonography (US) or mammography. Moreover, MRI aids in the concurrent staging of breast cancer upon detection or confirmation, assisting in treatment planning (5). MRI has an overall sensitivity 94.6% (range 85.7–100%) and specificity 74.2% (range 25–100%) (6). However, distinguishing between benign and malignant lesions may require a breast biopsy (7, 8). A limited number of detected lesions need MRI-guided biopsies due to their invisibility in other modalities (6). The incidence of malignancy in MRI-guided breast biopsies ranges from 18–60%, with most studies indicating rates between 20% and 35% (9–17) .

Performing MRI-guided breast biopsies presents challenges for radiologists (18). These include the availability of an MRI suit, difficulty related to contrast washout causing vanishing lesions, susceptibility artifacts obscuring the biopsy site, and limited access to posteromedial lesions. Achieving radiologic-pathologic concordance is crucial for an accurate diagnosis and appropriate patient management due to the overlapping imaging characteristics between benign and malignant lesions. Different institutions may have varying methods for conducting MRI-guided breast biopsies, leading to differences in clinicopathological outcomes (19, 20).

The objective of our study was to examine and document the results of MRI-guided breast biopsy, focusing on the indication and accuracy of MRI in comparison to histological assessment of breast masses in our general practice community.

Patients:

A retrospective analysis was performed on radiological records of 137 lesions from 137 women who had undergone MRI-guided biopsy due to MRI-positive and second-look US-negative findings between 2017 and 2023. The Pardis Noor Medical Imaging Center's ethics review committee (PNMIC-MR-1403-02) approved this study and waived any additional consent because all participants had already given their consent at the time of the biopsy. The study included patients with available previous MRI and subsequent histopathology reports. Twenty-eight results were excluded for various reasons, such as unavailable histopathology, unsuccessful biopsy attempts, and incomplete MRI reports. The final study group consisted of 109 lesions from 109 patients, with an average age of 45 ± 11 years (range: 22–76 years). Patients in this cohort underwent breast MRI due to the following reasons: screening and diagnostic. Screening was performed for asymptomatic women, regardless of previous history of breast carcinoma, who have identifiable risk characteristics for breast cancer in the majority of cases. Diagnostic purposes were employed in women who have recently been diagnosed with malignancy and are undergoing assessment of the breast consistent with MRI. This involves identifying any differences in location, size, or architecture between MRI and sonographic findings in order to determine the extent or appearance of lesions in either the same side or opposite breast. If US guidance was deemed unsuitable for establishing a pathological diagnosis, an MRI-guided core needle biopsy (CNB) was performed. If unintended MRI findings were detected while evaluating mammographic lesions and were not detected through additional mammography or sonography, an MRI-guided CNB was carried out. Additionally, MRI-guided CNB was conducted when mammography guidance was challenging due to limited visibility of the lesion in a single view or its location.

MRI-guided biopsy:

The patients underwent MRI scans using a 1.5 Tesla MRI system (Achieva, Philips Medical Systems, Best, Netherlands) in prone position. A bilateral dedicated seven-channel phased array breast coil (InVivo, Orlando, FL) was used for the scans. To prepare for a unilateral MRI-guided breast biopsy, compression was applied to the breast being examined using a dedicated sterile biopsy grid. A fiducial marker in the form of a Vitamin E capsule was placed on the biopsy grid in the region where the sample was to be taken. Localizing sequences were obtained, followed by unenhanced axial and contrast-enhanced axial and sagittal images to confirm the presence of the enhancing lesion that was previously observed on the MR image.

The MRI procedure consisted of a scan with a high level of detail for 2.5 minutes before and 10 seconds after the contrast was given. This was followed by another detailed scan to evaluate the delayed phase of enhancement. Gadoteric acid (Dotarem, Guerbet, Villepinte, France) is administered intravenously at a rate of 0.2 ml/sec with a dosage of 0.1 mmol/kg. The manual targeting approach utilized a biopsy sheet, necessitating precise translation of the estimated target from the "image" perspective to the "patient" perspective. We determined the coordinates of the augmenting lesion by measuring the distance between the closest reference marker and the lesion, eliminating the need for specialized software for an MRI-guided operation. The MRI table was relocated from the magnet's bore, and the needle guide was modified to match the specified grid address. We administered a local anesthetic by injecting a combination of lidocaine and bicarbonate solution in a 10:1 ratio after positioning the needle guide. Aseptic techniques were used to insert an 18-gauge standard Coaxial needle (manufactured by TSK Laboratory, Tochigi-Ken, Japan) to the predetermined depth, as indicated by the centimeter markings on the needle shaft. The needle was inserted using a lateral approach. Once the coaxial needle was positioned, the inner stylet was extracted. The coaxial cannula was inserted. Then, we moved the MRI table back to its original location inside the magnet's bore.

An axial sequence with restricted scope was performed to verify the precise positioning of the cannula in the location of the lesion. If adjustments were required, the cannula was relocated and another restricted axial sequence was captured to verify the location. After confirming the accurate positioning of the cannula, the MRI table was moved away from the magnet. Then, using an 18-gauge TSK semi-automated disposable core biopsy needle, several core samples of the lesion were collected through the coaxial cannula. On average, 5 core biopsies were taken for each lesion. The biopsies were conducted by a radiologist who had an average experience of 20 years. Following the conclusion of the biopsy, the coaxial cannula was extracted. On many occasions, a gold marker (specific manufacturer will be specified later) was inserted into the cannula following the sample process. Hemostasis was achieved by manually applying compression, followed by the application of a sterile dressing.

Data Collection:

The study involved retrospectively gathering records of various factors such as age, body mass index (BMI), patient symptoms, personal history of breast cancer, family history of breast cancer, pregnancy, menstrual status, risk factors, previous breast surgery, pathology reports, and findings of all MRI-guided breast biopsy cases from 2017 to 2023. Trained personnel collected incomplete data after contacting the patients. A highly skilled radiologist with 20 years of experience in breast imaging reevaluated the imaging findings of the breast biopsy cases. Lesions were categorized based on their location: left outer (LO), left inner (LI), right outer (RO), or right inner (RI). Additionally, the lesions detected through MRI were categorized using the breast imaging reporting and data system (BIRADS) lexicon. Breast core biopsies were further divided into benign, suspicious, or malignant pathological diagnostic categories. Within the benign category, subcategories included benign breast tissue not otherwise specified (n = 30), fibroadenoma (n = 2), proliferative fibrocystic changes not otherwise specified (12), and non-proliferative fibrocystic mastopathy not otherwise specified (n = 52). Malignant biopsies were classified as invasive ductal carcinoma (n = 5) and metastatic (n = 1), while the high-risk category included atypical ductal hyperplasia (n = 7).

Statistical Analysis:

Categorical data are presented as frequencies and percentages. The Chi2 and Fisher exact tests were used to compare the distribution of variables between two levels of enhancement. The sensitivity, specificity, positive predictive value, negative predictive value, and ROC curve were used to analyze the efficacy of the model diagnosis based on MRI. The statistical analysis was performed using Stata 16 software (StataCorp. 2019. Stata 16 Base Reference Manual. College Station, TX: Stata Press). Statistical significance was set to P < 0.05.

This study included 137 potentially eligible MRI-guided breast biopsies. Out of these, 28 lesions were excluded, leaving a total of 109 lesions in 109 patients. Among these, 55 patients had mass enhancement and 54 had non-mass enhancement lesions. The participants had a mean age of 45 ± 11 years (range: 22–76 years), and there was no significant association found between age and the presence of mass or non-mass lesions (p = 0.446). Both groups, with and without mass enhancement, had almost similar rates of normal, overweight, and obese BMI categories, indicating no significant difference between them (p = 0.964). The accompanying symptoms observed in the patients included blood discharge (10/109, 9.17%), milk discharge (4/109, 3.67%), watery discharge (3/109, 2.75%), mass (55/109, 50.46%), check-up (11/109, 10.09%), and pain (26/109, 23.85%). A statistically significant association was found between the history of pregnancy and the type of breast enhancement. Furthermore, Patients with mass enhancement had a higher BIRADS B4b, B4c, and B5 classification rate, while those with non-mass enhancement were more commonly classified as BIRADS B3 and B4a, indicating a lower likelihood of malignancy (p = 0.006). The details of the characteristics of our patients are seen in Table 1.

Lesions that underwent MRI-guided core biopsies showed a significant association between histopathology diagnoses and the presence of mass or non-mass lesions (p = 0.013). Only 1 out of 109 lesions (0.92%) with non-mass enhancement had malignant pathology, while the other 5 malignant lesions (4.59%) had mass enhancement. Furthermore, significance was seen in BIRADS categories, with histopathology having a P-value of 0.000. The majority of lesions with benign histopathology results were classified as BIRADS 4a (79 out of 109, 85.1%). On the other hand, lesions with high-risk or malignant histopathology results were classified as BIRADS 4b, 4c, and 5. Specifically, 12 out of 109 lesions (12.9%) fell into the BIRADS 4b category, 4 out of 109 lesions (4.3%) were categorized as BIRADS 4c, and 4 out of 109 lesions (4.3%) were classified as BIRADS 5 (Table 2).

We assessed the performance of the MRI BIRADS category in detecting malignancy based on the pathology by evaluating the sensitivity (SE), specificity (SP), positive predictive value (PPV), negative predictive value (NPV), and area under ROC curve. Overall, we found that the sensitivity and specificity of MRI for detecting malignancy were high for BIRADS categories 4c and 5, with values of 100% and 86%, respectively. When considering categories 4b, 4c, and 5, the sensitivity and specificity remained relatively high, at 92.3% and 91.7%. This suggests that while MRI with the BIRADS category system can lead to high sensitivity in detecting malignancy, it may also result in a higher number of false positives. Additionally, we discovered that the positive predictive value was relatively low for both categories, indicating a higher likelihood of false positives. However, the negative predictive value was high, demonstrating that MRI effectively identifies benign cases. (Table 3,4)

Table 1

Characteristic of patients based on mass and non-mass enhancement lesions in MRI.
Variables	Group	Total Population (N = 109)	Mass Enhancement	Non Mass Enhancement	P-value
Age (years) n (%)	=< 40	44 (40.37%)	19 (42.22%)	25 (39.06%)	0.446
Age (years) n (%)	> 40	65 (59.63%)	26 (57.78%)	39 (60.94%)	0.446
BMI n (%)	Normal	50 (45.87%)	20 (44.44%)	30 (46.88%)	0.964
	Overweight	45 (41.28%)	19 (42.22%)	26 (40.62%)
	Obese	14 (12.84%)	6 (13.33%)	8 (12.5%)
Patient’s Symptoms n (%)	Blood Discharge	10 (9.17%)	4 (8.89%)	6 (9.38%)	0.290
	Milk Discharge	4 (3.67%)	2 (4.44%)	2 (3.12%)
	Watery Discharge	3 (2.75%)	3 (6.67%)	0 (0.00%)
	Mass	55 (50.46%)	19 (42.22%)	36 (56.25%)
	Check up	11 (10.09%)	4 (8.89%)	7 (10.94%)
	Pain	26 (23.85%)	13 (28.89%)	13 (20.13%)
History of Self-Breast Cancer n (%)	No	97 (88.99%)	41 (91.11%)	56 (87.50%)	0.804
	Left Breast	7 (6.42%)	3 (6.67%)	4 (6.25%)
	Right Breast	5 (4.59%)	1 (2.22%)	4 (6.25%)
Family History of Breast Cancer n (%)	No	54 (49.54%)	26 (57.78%)	28 (43.75%)	0.271
	1st Degree	28 (25.69%)	11 (24.44%)	17 (26.56%)
	2nd Degree	27 (24.77%)	8 (17.78%)	19 (29.69%)
History of Pregnancy n (%)	No	21 (19.27%)	10 (22.22%)	11 (17.19%)	0.029
	1	30 (27.52%)	7 (15.56%)	23 (35.94%)
	2	35 (32.11%)	18 (40%)	17 (26.56%)
	3	12 (11.01%)	8 (17.78%)	4 (6.25%)
	4	8 (7.34%)	1 (2.22%)	7 (10.94%)
	5	2 (1.83%)	1 (2.22%)	1 (1.56%)
	6	1 (0.92%)	0	1 (1.56%)
Menstrual Cycle n (%)	Pre Menopause	46 (42.20%)	13 (28.89%)	33 (51.56%)	0.062
	Peri Menopause	16 (14.68%)	6 (13.33%)	10 (15.62%)
	Post Menopause	39 (35.78%)	22 (48.89%)	17 (26.56%)
	Unknown	8 (7.34%)	4 (8.89%)	4 (6.25%)
History of Previous Breast Surgery n (%)	No	83 (76.15%)	32 (71.11%)	51 (79.69%)	0.202
	Benign	14 (12.84%)	9 (20%)	5 (7.81%)
	Malignant	12 (11.01%)	4 (8.89%)	8 (12.50%)
Breast Lesion n (%)	LO	37 (33.94%)	12 (26.67%)	25 (39.06%)	0.253
	LI	12 (11.01%)	6 (13.33%)	6 (9.38%)
	RO	51 (46.79%)	25 (55.56%)	26 (40.62%)
	RI	9 (8.26%)	2 (4.44%)	7 (10.94%)
BIRADS n (%)	B3	10 (9.17%)	1 (2.22%)	9 (14.06%)	0.006
	B4a	79 (72.48%)	30 (66.67%)	49 (76.56%)
	B4b	12 (11.01%)	8 (17.78%)	4 (6.25%)
	B4c	4 (3.67%)	2 (4.44%)	2 (3.12%)
	B5	4 (3.67%)	4 (8.89%)	0 (.00%)

Table 2

MRI findings based on histopathology.
MRI findings	Histopathology diagnosis
MRI findings	Benign	High Risk	Malignant	P-value
Mass n (%)	35 (32.11%)	5 (4.59%)	5 (4.59%)	0.013
Non mass n (%)	61 (55.96%)	2 (1.83%)	1 (0.92%)	0.013
BIRADS 3 n (%)	10 (9.17%)	0	0	< 0.001
BIRADS 4a n (%)	78 (71.56%)	1 (0.92%)	0
BIRADS 4b n (%)	6 (5.50%)	5 (4.59%)	1 (0.92%)
BIRADS 4c n (%)	1 (0.92%)	1 (0.92%)	2 (1.83%)
BIRADS 5 n (%)	1 (0.92%)	0	3 (2.75%)

Table 3

Accuracy of BIRADS (4b + 4c + 5) in detecting lesions based on pathology
	Malignant Pathology	Benign Pathology	Measures
Abnormal n (%)	12 (11)	1 (0.92)	Sensitivity: 92.3% (64.0–99.8) Specificity: 91.7% (84.2–96.3) Positive Predictive Value: 60.0% (36.1–80.9) Positive Predictive Value: 98.9% (93.9–100.0) Exact diagnose (ROC area): 92% (0.84–1.00)
Normal n (%)	8 (7.34)	88 (80.74)
Total n (%)	20 (18.35)	89 (81.65)

Table 4

Accuracy of BIRADS (4c + 5) in detecting lesions based on pathology
	Malignant Pathology	Benign Pathology	Measures
Abnormal (n)	6 (5.51)	0	Sensitivity:100% (54.1–100.0) Specificity: 86% (78.2–92.4) Positive Predictive Value: 30.0% (11.9–54.3) Positive Predictive Value:100.0% (95.9–100.0) Positive Predictive Value: 93% (0.90–0.97)
Normal (n)	14 (12.84)	89 (81.65)
Total (n)	20 (18.35)	89 (81.65)

MRI is the most sensitive imaging modality for detecting invasive carcinoma and is comparable to mammography for detecting DCIS, among other imaging modalities used for breast cancer diagnosis (21).The detection rate for contralateral lesions in patients treated with unilateral breast cancer has been reported to range from 3–10% in various studies (22–25).

The present study aimed to assess the comparative accuracy of MRI and histological assessment of breast lesions within a general practice population. In women who underwent an MRI-guided biopsy, the incidence of malignancy was 5.50 percent (n = 6), which is almost similar to the findings of Myers et al (6) .Five individuals were diagnosed with invasive ductal carcinoma, but only one patient presented with metastatic cancer.

A strong association between the diagnosis of BIRADS using MRI and the presence of enhancement features in pathology reports was another result of our observation. The MRI demonstrated a 100% sensitivity and 86% specificity in detecting malignant histopathological abnormalities. In addition, the inclusion of high-risk lesions resulted in a shift in these values to 92.3% and 91.7%, respectively. Furthermore, we found that 6.42% of patients had high-risk pathology lesions which is almost lower than the results of a systematic review and meta-analysis conducted by Ozcan et al. (18). They aimed to assess the major performance metrics of MRI-guided breast biopsies on a sample of 11,087 patients. This review showed the pooled rates of histopathological outcomes for benign, high-risk, and malignant lesions, which were found to be 65.06% (95% CI: 59.15–70.54%), 16.69% (95% CI: 9.96–26.64%), and 29.64% (95% CI: 23.58–36.52%), respectively (18). It seems that the variation is likely attributed to disparities in patient demographics, research methodologies, and radiologists' criteria for suggesting biopsy (6). While we typically collect an average of 5 core biopsy samples at our institution, many institutions have reported receiving up to 12 samples (9). Given that our high-risk lesions are almost lower than the reported range, it may be suggested that more than the average of five consecutive samples were needed.

In our research, most of the high-risk and malignant lesions exhibited mass enhancement. We discovered a notable association between the enhancement characteristics seen during MRI-guided breast biopsies and the histology results. It is important to mention that prior research has shown that the risk of malignancy is greater in ME lesions compared to NME, with rates of 34–60% and 27–41%, respectively (14, 16, 26). However, Schnall et al. found a 94% negative predictive value for NME for invasive carcinoma but noted that the lack of enhancement on MRI did not rule out malignancy. This was further addressed by a retrospective assessment of tiny invasive carcinomas (< 5 mm) that did not enhance. This research indicated that NME is not always benign and that a large percentage of benign lesions may appear as EM and enhancement focus (EF).(8).

The application of the BIRADS classification to breast MRI presents challenges due to the absence of established criteria for categorizing BIRADS 4 in the official BIRADS lexicon for MRI. Consequently, there is a considerable variation in the probability of malignancy (ranging from > 2–95%) within this category, leading to the recommendation for biopsy in nearly all cases of BI-RADS 4 findings (27, 28). Nevertheless, the latest investigations have endeavored to further categorize BI-RADS 4 into subcategories A (indicating low suspicion), B (indicating moderate suspicion), and C (indicating strong suspicion), similar to other modes of breast imaging.

We observed a significant association between MRI BIRADS and histopathology. Similarly, the study conducted by Cha et al. examined 65 lesions using biopsied guided MRI and demonstrated a noteworthy association with lesions that they categorized as BIRADS subcategories (29). In a separate investigation conducted by Almeida et al., a total of 103 MRI-guided biopsies were obtained from 83 individuals. The researchers found that the BIRADS subcategory 4C exhibited the highest predictive value for malignancy (odds ratio [OR] 13.48; 95% CI 2.27–79.98) (30). Both the Cha et al. and Maltez de Almeida et al. research were limited by their failure to provide specific information regarding the division of 4A/B/C groups. Currently, our center endeavors to categorize BIRADS category 4 lesions during the interpretation of the MRI. Nevertheless, using explicit BIRADS 4A, 4B, and 4C classifications and conducting meticulous comparisons between radiology and pathology should potentially reduce the occurrence of superfluous MRI-guided biopsies.

Recent research has indicated that MRI exhibits a sensitivity of 94.6% (with a range of 85.7–100%) and a specificity of 74.2% (with a range of 25–100%)(31). The moderate specificity of breast MRI, coupled with its high sensitivity, contributes to a higher incidence of false positives and consequently leads to an elevated number of MRI-guided biopsies for benign tumors (21). Despite the existence of strict criteria for interpreting breast MRI, they lack the necessary specificity to identify whether a diagnosis is benign or malignant unambiguously. The breast MRI BI-RADS (4c + 5) and MRI BIRADS (4b + 4c + 5) had a sensitivity of 100.0% (54.1–100.0) and 92.3% (64.0–99.8), respectively, according to our data. The specificity rates for breast MRI BI-RADS (4c + 5) and breast MRI BIRADS (4b + 4c + 5) were found to be 86.4% (78.2–92.4) and 91.7% (84.2–96.3), respectively.

The importance of radiologic and pathologic association in breast MRI interpretation should be considered, as it plays a critical role in reducing the occurrence of benign biopsies, relieving patient distress, and reducing healthcare expenses. Prakash et al. conducted a study that found a association between peer review in radiology-pathology and a decrease in surgical excisions. The study revealed that weekly association conferences had an impact on up to 5.3% of cases, leading to surgery avoidance in 2.1% of cases (32).

There are various limitations in our investigation. The retrospective nature of this investigation resulted in a lack of specificity in the descriptions of lesions. Furthermore, in a few instances where patients underwent MRI prior to biopsy and outside of our medical facility, the image quality was occasionally insufficient, or just the reports were accessible. One further constraint pertains to the inadequate monitoring of multiple instances that exhibited inconsistent results, a pathologic diagnosis that was either high-risk or borderline, and the postponement of biopsy procedures. An effort for thorough follow-up was requested and could have influenced some of the results of this study.

In summary, our study shows that MRI-guided biopsies are highly precise and responsive in identifying malignant breast lesions even with manual calculation method. The importance of MRI in diagnosing breast cancer is emphasized by its high sensitivity and specificity for malignant histopathological lesions, especially when used with high-risk lesions. The study also highlights the need to clearly sub-classify BI-RADS 4 lesions to reduce unnecessary biopsies using MRI. Additionally, this study emphasizes the importance in interpreting breast MRI to minimize false positives and unnecessary biopsies. Furthermore, these findings support the continued use of MRI guided biopsy as a crucial tool in diagnosing breast cancer and emphasize the need for ongoing progress and consistency in interpreting breast MRI.

MRI: Magnetic resonance imaging

US: ultrasonography

CNB: core needle biopsy

LO: left outer

LI: left inner

RO: right outer

RI: right inner

BMI: body mass index

BIRADS :breast imaging reporting and data system

SE: sensitivity

SP: specificity

PPV: positive predictive value

NPV: negative predictive value

Funding: No fund

Data Availability: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Ethics approval and consent to participate

The study was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the Ethics Committee of Pardis Noor Medical Imaging Center and written informed consent was waived any additional consent because all participants had already given their consent at the time of the biopsy (PNMIC-MR-1403-02).

Authors’ contributions:

Fattaneh Khalaj: Writing – original draft, Conceptualization

Zahra Moradi: Writing – original draft

Amir Kasaeian: Data curation; Formal analysis

Hamed Ghorani, Mohammad Hosein Golazar: Investigation

Shahram Akhlaghpoor: Conceptualization; Resources; Writing– review & editing.

Acknowledgements: Not applicable

Consent for publication: Not applicable.

Competing interests: The authors declare that they have no competing interests.

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No competing interests reported.

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29 Aug, 2024
Editor invited by journal
28 Jul, 2024
Editor assigned by journal
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First submitted to journal
10 Jul, 2024

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Simple MR Guided Breast Biopsy Strategy: technique and radiological-pathological association

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Version 1

Abstract

Background

Methods

Results

Conclusions

Background

Methods

Patients:

MRI-guided biopsy:

Data Collection:

Statistical Analysis:

Results

Discussion

Conclusion

Abbreviations

Declarations

References

Additional Declarations

Status:

Version 1