A beep was heard each time a specimen was acquired. The scope of American Journal of Roentgenology covers Medicine (miscellaneous) (Q1), Radiology, Nuclear Medicine and Imaging (Q1). MRI-guided vacuum-assisted biopsy, pioneered by Sylvia Heywang-Kobrunner, has advantages compared with other biopsy methods for the diagnosis of MRI-detected lesions [25]. While the postexamination images were being acquired, the technologist retrieved the samples from the collecting chamber and placed them in formalin. The four screening-detected cancers were in two women: one woman with bilateral breast cancer and one woman with multifocal invasive breast cancer. The median time for a round of tissue acquisition was 38 sec (mean, 41 sec; range, 29–87 sec). About AJR. American Journal of Roentgenology with Read by QxMD. Listen to the latest podcasts by selecting one of the following: 10.2214/AJR.18.21007 10.2214/AJR.18.20396 The obturator was not placed inside the patient at this point, but rather measured to determine where to set the depth stop (Fig. The median histologic size of infiltrating carcinoma was 0.8 cm (range, 0.2–1.5 cm). At our institution, diagnostic breast MRI examinations were performed with the patient prone in a 1.5-T commercially available system (Signa, General Electric Medical Systems, Milwaukee, WI) using a dedicated surface breast coil. Laura Liberman 1, Elizabeth A. Morris 1, D. David Dershaw 1, Cynthia M. Thornton 1, Kimberly J. The radiologist reviewed the postbiopsy mammogram to assess for air, hematoma, or both; to assess whether the clip was identified; and to calculate the maximum distance between the clip and the localizing wire. Those results represent the culmination of nearly two years of open research by FAIR and NYU Langone Health, which is a group of academic medical centers in New York City. An ultrafast sequence provides early enhancement of lesion characteristics that optimize the characterization of the fast protocol, increasing positive predictive values without increasing time. In 23 lesions, only a single round of tissue acquisition was necessary; in four lesions, MRI after the first round of tissue acquisition did not ensure lesion sampling, and a second round of tissue acquisition was performed. Like many of the more long-lived academic publications, there have been a number of name changes over the years (see below). We injected a generous wheal of anesthetic to increase breast thickness. Address correspondence to I. Thomassin-Naggara (, Original Research. High risk lesions such as atypical ductal hyperplasia and LCIS will very likely be more prevalent at percutaneous biopsy in women having breast MRI because they are at high risk for breast cancer than in the general population [36]. A new clinical study to be published in the American Journal of Roentgenology shows for the first time that fastMRI images are interchangeable with those of regular MRIs. However, “second-look” sonography fails to identify a sonographic correlate in up to 77% of MRI-detected lesions referred for biopsy [5–7]. We encountered some difficulties with clip deployment, with a second attempt necessary in almost one quarter of the cases. For the two lesions that were posterior to the grid, the skin incisions were made as close to the lesions as possible, posteriorly within the grid, and suction was applied in the posterior direction to acquire tissue. The protocol was to obtain at least six specimens. 1E). Gadopentetate dimeglumine, 0.1 mmol/L per kilogram of body weight, was injected IV as a rapid bolus injection through an indwelling IV catheter, and acquisition of sagittal images (3-mm slice thickness) started immediately after contrast injection. However, the clip can be readily identified on mammography. Favorites; PDF. This case, therefore, may reflect a false-negative on the part of the MRI study rather than the biopsy procedure. Dibandingkan dengan Faktor Dampak historis, Faktor Dampak 2019 dari American Journal of Roentgenology turun 3.92 %. The median size of these 27 lesions was 1.0 cm (range, 0.4–6.4 cm). The indication for breast MRI in these 20 women was assessment of disease extent in women with known cancer diagnosed within 6 months of breast MRI in 10 and screening of women who are at high-risk for breast cancer in 10. Compared with historical Journal Impact data, the Metric 2019 of American Journal of Roentgenology dropped by 3.92% . The tray with the stylet was removed from the room before MRI was performed. In the latter three lesions, the distances from the clip to the wire were 3.4, 4.0, and 4.1 cm, respectively; all three clips were deep (medial) in relation to the localizing wires. The median time to perform MRI-guided vacuum-assisted biopsy, from the original axial localizing images to the final images obtained after clip deployment, was 35 min (mean, 35 min; range, 24–48 min) for a single lesion and 65 min (mean, 69 min; range, 62–86 min) for two lesions. Country of Publication. Publication Start Year. The American Roentgen Ray Society, founded in 1900, is the first and oldest radiology society in the United States. The median size of 27 MRI-detected lesions that had biopsy was 1.0 cm (range, 0.4–6.4 cm). Imaging–histologic correlation, essential after breast biopsy using any guidance method [34], is particularly important after MRI-guided biopsy because of the limitations of other methods to confirm lesion retrieval. American journal of roentgenology. Citation: American Journal of Roentgenology. MRI-guided breast biopsy is a challenging endeavor because of the requirement for specific MRI-compatible equipment, the need to remove the patient from the magnet to perform the biopsy, limited access to the medial and posterior breast, decreasing lesion conspicuity during the procedure (the “vanishing” target), needle artifact obscuring the lesion site, desirability of placing a localizing clip, and limitations in confirming lesion retrieval [8]. The monthly American Journal of Roentgenology is a highly respected peer-reviewed journal with a worldwide circulation of close to 25,000. History In conclusion, our initial experience suggests that MRI-guided vacuum-assisted biopsy is a fast, safe, and accurate procedure. MRI-Guided Vacuum-Assisted Breast Biopsy Performed at 3 T With a 9-Gauge Needle: Preliminary Experience, Accuracy of MRI in the Detection of Residual Breast Cancer After Neoadjuvant Chemotherapy, Fast MRI-Guided Vacuum-Assisted Breast Biopsy: Initial Experience. Image acquisition started after injection of contrast material and saline bolus. The goal of the ARRS is maintained through an annual scientific and educational meeting and through publication of the American Journal of Roentgenology, … Other maneuvers described for stereotactic biopsy that may be useful for MRI-guided biopsy of thin breasts include extrinsic circumferential pressure on the breast and use of a reverse-compression paddle; with the latter method, when the probe is placed deep into the breast, it displaces the skin and subcutaneous tissues into the aperture on the side opposite the skin entry site without piercing the skin [40]. A paper written by the team describing the new technology is to be published in the American Journal of Roentgenology. 2019;213:485-489. Further work with more women is necessary, including optimization of equipment and techniques for biopsy and clip placement, potential use of long-acting contrast agents, imaging–histologic correlation, and long-term follow-up, so that we can offer women the benefits of MRI in detecting breast cancer while minimizing surgeries for lesions that are benign. The sixth cancer was a 0.7-cm mass in which the imaging target may have been excised at MRI-guided vacuum-assisted biopsy, and histologic analysis of vacuum-assisted biopsy specimens yielded infiltrating lobular carcinoma; the surgical specimen showed fibrosis and changes related to prior biopsy, with no residual carcinoma (Fig. Obtaining a two-view mammogram after biopsy is essential to assess location of the clip with respect to the biopsy cavity. CONCLUSION. The stylet was then placed through the needle guide in the appropriate orientation with the tip protruding only slightly from the far side of the needle guide, and the tip of the stylet was placed in the skin at the site of the scalpel incision before attaching the needle guide to the grid. In approximately one quarter of lesions (23%), cancer was found at MRI-guided vacuum-assisted biopsy. Since less data is required, MRI scans could run nearly 4x faster. There were discussions about officially renaming AJR as the American Journal of Radiology in the mid-1970s but it was decided that the original name had importan… Gadolinium Retention and Breast MRI Screening: More Harm Than Good? The initial attempt at clip placement was successful in 20 (77%) of 26 lesions, and a second attempt was successful in five (19%) of 26 lesions; in one lesion (4%), clip placement failed in spite of two attempts. They radiologists found the … For MRI-detected lesions warranting biopsy, correlative sonography was performed at the discretion of the radiologist interpreting the MRI study; if a sonographic correlate was identified, biopsy or localization was usually performed under sonographic guidance. Preparing the probe.—The clear obturator was placed inside the white introducer, and the depth stop was set so that it was the appropriate distance from the tip of the clear obturator. Scientific Journal Selector (2018-2019), we collect latest information of SCI journals, include ISSN, h-index, CiteScore, online submission URL, research … Single lesions in 11 women underwent biopsy and two lesions in eight women underwent biopsy. 1F). One complication was encountered, a hematoma that resolved with compression. OBJECTIVE. A clip can enable subsequent localization under the guidance of mammography (or sonography, if it is sonographically evident). 5A, 5B, 5C): the reported sensitivity of MRI for DCIS has ranged from 40% to 100% [37]. Compared with fine-needle aspiration biopsy, vacuum-assisted biopsy has a higher technical success rate and fewer inadequate specimens [11, 15, 19–21]. If you use the fastMRI data or this code in your research, please consider citingthe fastMRI dataset paper: Histologic underestimation was observed in one lesion. The stylet was advanced to the depth stop (Fig. One complication occurred: a hematoma that resolved with compression. The clear obturator was then removed from the white introducer, and the sharp stylet was placed inside the white introducer as far as it could go (Fig. The hematoma resolved with compression and did not delay subsequent surgery. 10.2214/ajr.184.6.01841782. 10.2214/AJR.19.21924 In this series, authors of select AJR articles discuss how their studies were performed, the results, and how the studies changed their practices. The clip introducer was turned 180° and removed, the biopsy handpiece was removed and inspected to make sure that the clip had not been retained in the mouth, and the introducer was removed. OBJECTIVE. Fast MRI-Guided Vacuum-Assisted Breast Biopsy: Initial Experience. Among women with cancer in one breast, MRI detects additional sites of cancer in the ipsilateral breast in 6–34% [2] and detects an otherwise unsuspected cancer in the contralateral breast in 4–24% [3]. The front end of the probe was placed back into the introducer. Thin breasts pose challenges for MRI-guided vacuum-assisted biopsy, as for stereotactic biopsy [40]. NYU Langone Health and Facebook teamed up to launch the fastMRI initiative two years ago in a bid to speed up MRI scans. Cancer was found at vacuum-assisted biopsy in six (22%) of 27 lesions. If the obturator was superficial in relation to the lesion, the obturator was removed, leaving the introducer in place. In our initial experience with a new method, the technical success rate of MRI-guided vacuum-assisted biopsy was 95%. The Journal Impact 2019-2020 of American Journal of Roentgenology is 3.190, which is just updated in 2020. Previous studies have shown that the likelihood of undergoing a single therapeutic operation is significantly higher in women with cancers diagnosed by percutaneous biopsy rather than surgical biopsy [32]. 1C). A vitamin E marker was placed over the expected lesion site (Fig. Data were entered into a computerized spreadsheet (Excel, Microsoft, Redmond, WA) for analysis. Breast MRI can detect cancer that is mammographically and clinically occult. 1G). In one woman, the biopsy device could not be inserted because of hold-up of the white plastic introducer at the skin surface; the vacuum-assisted biopsy was aborted, and the lesion underwent needle localization and surgical excision. The needle guide was oriented so that one of the holes would be in the appropriate location. MRI review suggests that the MRI target may have been excised and that the microscopic DCIS in the surgical specimen was occult at MRI (Fig. The diagnosis of atypical ductal hyperplasia at percutaneous biopsy is an indication for surgical excision [32]. The control module was outside the MRI scanner; only the foot pedal and biopsy device came into the room with the magnet. The ability to position the vacuum-assisted biopsy device adjacent to the lesion and still acquire tissue from the lesion is another advantage of vacuum-assisted biopsy over automated core biopsy [32]. 1D). Determining lesion location and desired depth of probe insertion.—After images were reviewed at the console, a cursor was placed over the lesion on the monitor. The results, published in the American Journal of Roentgenology, found no significant differences in the radiologists’ evaluations. The median maximal distance from the clip to the localizing wire was 0.6 cm (range, 0.1–4.1 cm). American Journal of Roentgenology, AJR The official journal of the American Roentgen Ray Society. False-negative results are a potential problem during any biopsy: reported false-negative rates are 0–8% for stereotactic 14-gauge automated core biopsy, 3% for stereotactic 11-gauge vacuum-assisted biopsy, and 0–8% for needle localization and surgical biopsy [38, 39]. Vacuum-assisted biopsy and surgical histology are correlated in Table 1. The results, published in the American Journal of Roentgenology, found no significant differences in the radiologists' evaluations. A faster biopsy also enables increased throughput in the magnet and is more comfortable for the patient. The depth (z-axis) coordinate of the lesion was determined on the basis of the relationship between the lesion and the skin surface. MRI-guided needle localization.—After MRI-guided vacuum-assisted biopsy and clip placement had been completed, MRI-guided needle localization was performed using previously described methods [17] with an MRI-compatible hookwire (MReye Modified Kopans Spring Hook Localization Needle [20-gauge], Cook, Bloomington, IN). The depth of the skin surface from the outer aspect of the needle guide was 20 mm (because the needle guide was 2-cm thick). The median size of the MRI lesions in these eight cancers was 1.1 cm (range, 0.6–6.5 cm). For example, if the lesion was 30 mm deep in relation to the skin, the desired distance from the tip of the obturator to the depth stop was 50 mm (30 + 20 = 50 mm). The mammogram obtained after biopsy confirmed a 3-cm soft-tissue mass with air, consistent with the clinically evident hematoma. The distance from the clip to the localizing wire was 1 cm or less in 19 (76%) of 25 lesions, 1.1 cm in three lesions (12%), and greater than 3 cm in three lesions (12%). Monthly. Targeting images.—The patient was positioned prone with both breasts in a dedicated surface breast coil (Open Breast Array Coil, model OBC, MRI Devices, Waukesha, WI). Placement of a localizing clip, attempted in 26 lesions, was successful in 25 (96%) of 26, and the clip was retrieved on specimen radiography in 22 (96%) of 23. Previous studies have reported technical success rates of 61–100% for MRI-guided fine-needle aspiration [11, 15, 19–21], 33–100% for MRI-guided automated core biopsy [12, 15, 22–24], and 93–98% for MRI-guided vacuum-assisted biopsy [25, 28]. United States. A skin nick was made with a scalpel. An axial localizing T1-weighted sequence was performed, and the volume of interest was selected to include the compression device and a vitamin E marker placed over the expected lesion site. At our institution, the main indications for breast MRI are screening of women who are at high risk for breast cancer, assessment of disease extent in women with known breast cancer, and problem solving. One woman declined placement of a clip. Although it remains controversial, excision may also be warranted for lesions yielding LCIS at percutaneous biopsy [35]. Among these eight cancers, five were infiltrating cancer (infiltrating ductal in two, infiltrating ductal and lobular in two, and infiltrating lobular in one) and three were ductal carcinoma in situ (DCIS). In women at high risk of developing breast cancer, MRI detects a cancer occult to mammography and physical examination in 2–8% [1]. We hypothesize that the diagnosis of cancer by MRI-guided vacuum-assisted biopsy, like diagnosis of cancer by stereotactic or sonographically guided biopsy, will expedite patient management. One woman at high risk for breast cancer who was 19 years old did not have a mammogram; in the remaining 19 women, mammographic parenchymal density [30] was class 4 (dense) in one, class 3 (heterogeneously dense) in 14, and class 2 (scattered fibroglandular densities) in four. ... Official journal of the American Roentgen Ray Society, 1976- and the American Radium Society, 1976-1980. online access After the examination, the unenhanced images were subtracted from the first contrast-enhanced images on a pixel-by-pixel basis. I. Thomassin-Naggara has provided remunerated lectures for GE Healthcare, Guerbet, Hologic, Canon, and Samsung and serves on advisory boards for Siemens Healthineers and Bard. Some posterior lesions cannot be captured within the biopsy grid, a problem that can also be encountered when performing stereotactic biopsy with the patient in the prone position [40]. The society has been a forum for progress in radiology since shortly after the discovery of the X ray and is dedicated to the goal of the advancement of medicine through the science of radiology and its allied sciences. A false-negative finding was defined as a lesion yielding benign results without atypia at vacuum-assisted biopsy and cancer at surgery. Musculoskeletal radiologists reviewed two sets of knee MRIs from 108 patients, one set using the standard imaging techniques, and one set using the fastMRI AI model. 2020;214: 282-295. MRI-guided biopsy was performed with a vacuum-assisted probe, followed by placement of a localizing clip, and then needle localization for surgical excision. Indications for Breast MRI and MRI-Guided Needle Localization, MRI-Guided Vacuum-Assisted Biopsy Technique, Review of Mammograms Obtained After Biopsy, Correlating Vacuum-Assisted Biopsy and Surgical Histology, Original Research. Imaging-Based Approach to Axillary Lymph Node Staging and Sentinel Lymph Node Biopsy in Patients With Breast Cancer, Review. Seventeen were mass lesions and 10 were non–mass lesions. We thank the 20 women who enrolled in the study for making this work possible. The high proportion of benign lesions encountered emphasizes the potential benefit of MRI-guided vacuum-assisted biopsy, which may spare most women with MRI-detected lesions the need for surgical excision. Therefore, the desired depth of insertion of the center of the collecting area (the “mouth”) of the vacuum-assisted biopsy probe from the outer aspect of the needle guide (in millimeters) was 20 plus z, where z was the calculated depth of the lesion (in millimeters) from the skin surface. Predictors for Failing the American Board of Radiology Core Examination Gary Lloyd Horn , Stephen Herrmann , Irfan Masood , Clark R. Andersen , Quan Dang Nguyen American Journal of Roentgenology . The utility of breast MRI is dependent on the availability of methods to perform biopsy of lesions detected on MRI only. In two of these three lesions, MRI review indicated that the clip had deployed deep in relation to the biopsy site; in the third, the clip was at the biopsy site, but the wire had migrated superficially, perhaps because it was not firmly anchored in the biopsy cavity. MRI-guided biopsy of a smooth mass yielded fibroadenoma and fibrosis; surgery revealed microscopic DCIS. MRI-Guided Breast Biopsy: Influence of Choice of Vacuum Biopsy System on the Mode of Biopsy of MRI-Only Suspicious Breast Lesions, Technical Innovation. A sagittal T1-weighted MRI study (3-mm slice thickness) was then performed to document the location of the obturator, with the ideal location of the tip of the obturator being at the site of the lesion. The stylet was removed, and the clear obturator was placed inside the white plastic introducer to assist in MRI confirmation of location. Some non-North American radiologists think that AJR stands for the American Journal of Radiology; however, it has always been short for the American Journal of Roentgenology, or a close variant of this. Frequency was in the anteroposterior direction. The current editor-in-chief is Thomas H. Berquist. SDC. fastMRI: An open dataset and benchmarks for accelerated MRI arXiv Code Website Accelerating Magnetic Resonance Imaging (MRI) by taking fewer measurements has the potential to reduce medical costs, minimize stress to patients and make MRI possible in applications where it is currently prohibitively slow or expensive. Clip placement was attempted in 26 lesions and was successful in 25 (96%) of 26. For more than 100 years the AJR has been recognized as one of the best specialty journals in the world. Compression with ice after biopsy followed by a pressure dressing may be helpful in this regard. MRI-guided vacuum-assisted biopsy is a fast, safe, and accurate alternative to surgical biopsy for breast lesions detected on MRI. In more than two thirds of the lesions (70%), both vacuum-assisted biopsy and surgery yielded benign results. In one smooth mass that yielded fibroadenoma at vacuum-assisted biopsy, a mammogram obtained after biopsy showed that the clip was 4.0 cm deep (medial) in relation to the lesion. 4A, 4B). For MRI-detected lesions warranting biopsy that had neither mammographic nor sonographic correlates, MRI-guided localization and surgical excision were performed [17]. The biopsy was technically successful in 19 (95%) of 20 women. Kuartil Faktor Dampak American Journal of Roentgenology adalah Q1 . SUBJECTS AND METHODS. Biopsy of suspicious MRI-detected lesions is necessary for definitive diagnosis. The nipple, which enhanced at MRI, was excised without localization and yielded DCIS. The Journal Impact Quartile of American Journal of Roentgenology is Q1 . 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