European Radiology

, Volume 16, Issue 8, pp 1811–1817

MRI-guided needle localization of suspicious breast lesions: results of a freehand technique

  • M. A. A. J. van den Bosch
  • B. L. Daniel
  • S. Pal
  • K. W. Nowels
  • R. L. Birdwell
  • S. S. Jeffrey
  • D. M. Ikeda


Magnetic resonance imaging (MRI) can detect clinically and mammographically occult breast lesions. In this study we report the results of MRI-guided needle localization of suspicious breast lesions by using a freehand technique. Preoperative MRI-guided single-needle localization was performed in 220 patients with 304 MRI-only breast lesions at our hospital between January 1997 and July 2004. Procedures were performed in an open 0.5-T Signa-SP imager allowing real-time monitoring, with patient in prone position, by using a dedicated breast coil. MRI-compatible hookwires were placed in a noncompressed breast by using a freehand technique. MRI findings were correlated with pathology and follow-up. MRI-guided needle localization was performed for a single lesion in 150 patients, for two lesions in 56 patients, and for three lesions in 14 patients. Histopathologic analysis of these 304 lesions showed 104 (34%) malignant lesions, 51 (17%) high-risk lesions, and 149 (49%) benign lesions. The overall lesion size ranged from 2.0–65.0 mm (mean 11.2 mm). No direct complications occurred. Follow-up MRI in 54 patients showed that two (3.7%) lesions were missed by surgical biopsy. MRI-guided freehand needle localization is accurate and allows localization of lesions anterior in the breast, the axillary region, and near the chest wall.


Magnetic resonance imaging (MRI) Breast Needle localization Freehand technique 


  1. 1.
    Orel SG, Schnall MD, LiVolsi VA et al (1994) Suspicious breast lesions: MR imaging with radiologic-pathologic correlation. Radiology 190:485–493PubMedGoogle Scholar
  2. 2.
    Hulka CA, Smith BL, Sgroi DC et al (1995) Benign and malignant breast lesions: differentiation with echo-planar MR imaging. Radiology 197:33–38PubMedGoogle Scholar
  3. 3.
    Berg WA, Gutierrez L, NessAiver MS et al (2004) Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer. Radiology 233:830–849PubMedCrossRefGoogle Scholar
  4. 4.
    Boetes C, Mus RD, Holland R et al (1995) Breast tumors: comparative accuracy of MR imaging relative to mammography and US for demonstrating extent. Radiology 197:743–747PubMedGoogle Scholar
  5. 5.
    Hata T, Takahashi H, Watanabe K et al (2004) Magnetic resonance imaging for preoperative evaluation of breast cancer: a comparative study with mammography and ultrasonography. J Am Coll Surg 198:190–197PubMedCrossRefGoogle Scholar
  6. 6.
    Daniel BL, Yen YF, Glover GH et al (1998) Breast disease: Dynamic spiral MR imaging. Radiology 209:499–509PubMedGoogle Scholar
  7. 7.
    Yen YF, Han KF, Daniel BL et al (2000) Dynamic breast MRI with spiral trajectories: 2D versus 3D. J Magn Reson Imaging 11:351–359PubMedCrossRefGoogle Scholar
  8. 8.
    Leong CS, Daniel BL, Herfkens RJ et al (2000) Characterization of breast lesion morphology with delayed 3DSSMT: an adjunct to dynamic breast MRI. J Magn Reson Imaging 11:87–96PubMedCrossRefGoogle Scholar
  9. 9.
    Stomper PC, Herman S, Klippenstein DL et al (1995) Suspect breast lesions: Findings at dynamic gadolinium-enhanced MR imaging correlated with mammographic and pathologic features. Radiology 197:387–395PubMedGoogle Scholar
  10. 10.
    Kriege M, Brekelmans CT, Boetes C et al (2004) Efficacy of MRI and mammography for breast-cancer screening in women with a familial or genetic predisposition. N Engl J Med 351:427–437PubMedCrossRefGoogle Scholar
  11. 11.
    Orel SG, Schnall MD, Newman RW et al (1994) MR imaging guided localization and biopsy of breast lesions: initial experience. Radiology 193:97–102PubMedGoogle Scholar
  12. 12.
    Morris EA, Liberman L, Dershaw DD et al (2002) Preoperative MR imaging-guided needle localization of breast lesions. AJR Am J Roentgenol 178:1211–1220PubMedGoogle Scholar
  13. 13.
    Kuhl CK, Elevelt A, Leutner CC et al (1997) Interventional breast MR imaging: clinical use of a stereotactic localization and biopsy device. Radiology 204:667–675PubMedGoogle Scholar
  14. 14.
    Heywang-Kobrunner SH, Heinig A, Pickuth D et al (2000) Interventional MRI of the breast: lesion localization and biopsy. Eur Radiol 10:36–45PubMedCrossRefGoogle Scholar
  15. 15.
    Daniel BL, Birdwell RL, Ikeda DM et al (1998) Breast lesion localization: a freehand, interactive MR imaging-guided technique. Radiology 207:455–463PubMedGoogle Scholar
  16. 16.
    Daniel BL, Butts K, Glover GH et al (1998) Breast cancer: gadolinium-enhanced MR imaging with a 0.5-T open imager and three-point Dixon technique. Radiology 207:183–190PubMedGoogle Scholar
  17. 17.
    Daniel BL, Birdwell RL, Butts K et al (2001) Freehand iMRI-guided large-gauge core needle biopsy: a new minimally invasive technique for diagnosis of enhancing breast lesions. J Magn Reson Imaging 13:896–902PubMedCrossRefGoogle Scholar
  18. 18.
    Ikeda DM, Hylton NM, Kinkel K et al (2001) Development, standardization, and testing of a lexicon for reporting contrast-enhanced breast magnetic resonance imaging studies. J Magn Reson Imaging 13:889–895PubMedCrossRefGoogle Scholar
  19. 19.
    Lampe D, Hefler L, Alberich T et al (2002) The clinical value of preoperative wire localization of breast lesions by magnetic resonance imaging: a multicenter study. Breast Cancer Res Treat 75:175–179PubMedCrossRefGoogle Scholar
  20. 20.
    Bedrosian I, Schlencker J, Spitz FR et al (2002) Magnetic resonance imaging-guided biopsy of mammographically and clinically occult breast lesions. Ann Surg Oncol 9:457–461PubMedCrossRefGoogle Scholar
  21. 21.
    Pfleiderer SO, Reichenbach JR, Azhari T et al (2003) Dedicated double breast coil for magnetic resonance mammography imaging, biopsy, and preoperative localization. Inv Radiol 38:1–8CrossRefGoogle Scholar
  22. 22.
    Lehman CD, Aikawa T (2004) MR-guided vacuum-assisted breast biopsy: accuracy of targeting and success in sampling in a phantom model. Radiology 232:911–914PubMedCrossRefGoogle Scholar
  23. 23.
    Jackman RJ, Marzoni FA (1997) Needle-localized breast biopsy: why do we fail? Radiology 204:677–684PubMedGoogle Scholar
  24. 24.
    Fischer U, Kopka L, Grabbe E (1998) Magnetic resonance guided localization and biopsy of suspicious breast lesions. Top Magn Reson Imaging 9:44–59PubMedCrossRefGoogle Scholar
  25. 25.
    Smith LF, Henry-Tillman R, Mancino AT et al (2001) Magnetic resonance imaging-guided core needle biopsy and needle localized excision of occult breast lesions. Am J Surg 182:414–418PubMedCrossRefGoogle Scholar
  26. 26.
    Helbich TH (2001) Localization and biopsy of breast lesions by magnetic resonance imaging guidance. J Magn Reson Imaging 13:903–911PubMedCrossRefGoogle Scholar
  27. 27.
    Hefler L, Casselman J, Amaya B et al (2003) Follow-up of breast lesions detected by MRI not biopsied due to absent enhancement of contrast medium. Eur Radiol 13:344–346PubMedGoogle Scholar
  28. 28.
    Kuhl CK, Morakkabati N, Leutner CC et al (2001) MR Imaging-guided large-core (14-gauge) needle biopsy of small lesions visible at breast MR imaging alone. Radiology 220:31–39PubMedGoogle Scholar
  29. 29.
    Paakko E, Reinikainen H, Lindholm EL, Rissanen T (2005) Low-field versus high-field MRI in diagnosing breast disorders. Eur Radiol 15:1361–1368PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • M. A. A. J. van den Bosch
    • 1
    • 2
  • B. L. Daniel
    • 1
  • S. Pal
    • 1
  • K. W. Nowels
    • 3
  • R. L. Birdwell
    • 1
  • S. S. Jeffrey
    • 4
  • D. M. Ikeda
    • 1
    • 5
  1. 1.Department of RadiologyStanford University Medical CenterStanfordUSA
  2. 2.Department of RadiologyUniversity Medical Center UtrechtCX UtrechtThe Netherlands
  3. 3.Department of PathologyStanford University Medical CenterStanfordUSA
  4. 4.Department of SurgeryStanford University Medical CenterStanfordUSA
  5. 5.Department of RadiologyStanford Center for Advanced MedicineStanfordUSA

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