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Innovative strategies for minimizing hematoma risk in MRI-guided breast biopsies

Michael P Brönnimann

Michael P Brönnimann

  • Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of BernBern, Switzerland
  • Department of Radiology, Charité – Universitätsmedizin, BerlinBerlin, Germany
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Brönnimann, Michael P
, 
Matthew T McMurray

Matthew T McMurray

Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of BernBern, Switzerland
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McMurray, Matthew T
, 
Johannes T Heverhagen

Johannes T Heverhagen

Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of BernBern, Switzerland
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Heverhagen, Johannes T
, 
Andreas Christe

Andreas Christe

Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of BernBern, Switzerland
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Christe, Andreas
, 
Corinne Wyss

Corinne Wyss

Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of BernBern, Switzerland
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Wyss, Corinne
, 
Alan A Peters

Alan A Peters

Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of BernBern, Switzerland
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Peters, Alan A
, 
Adrian T Huber

Adrian T Huber

  • Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of BernBern, Switzerland
  • Department of Nuclear Medicine and Radiology, Cantonal Hospital LucerneLucerne, Switzerland
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Huber, Adrian T
, 
Florian Dammann

Florian Dammann

Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of BernBern, Switzerland
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Dammann, Florian
 und 
Verena C Obmann

Verena C Obmann

Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of BernBern, Switzerland
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Obmann, Verena C
  
22. Jan. 2025
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Artikel-Kategorie: research article
Online veröffentlicht: 22. Jan. 2025
Seitenbereich: 91 - 99
Eingereicht: 27. Aug. 2024
Akzeptiert: 12. Nov. 2024
DOI: https://doi.org/10.2478/raon-2025-0004
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© 2025 Michael P Brönnimann et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

FIGURE 1.

Flowchart shows the study population.
Flowchart shows the study population.

FIGURE 2.

MRI-guided breast biopsy with hematoma as a sequela. (A) Target lesion in the lower outer quadrant. (B) Biopsy needle in target position. (C) After vacuum-assisted biopsy, a hematoma has formed. Within it, a recognizable susceptibility artifact is due to the marker.
MRI-guided breast biopsy with hematoma as a sequela. (A) Target lesion in the lower outer quadrant. (B) Biopsy needle in target position. (C) After vacuum-assisted biopsy, a hematoma has formed. Within it, a recognizable susceptibility artifact is due to the marker.

FIGURE 3.

Illustration of the measurements. (A) In blue, the distance from the lesion to the nipple. A circle was drawn around the target lesion to capture the proportion of the surrounding mammary gland. These measurements were taken after multiplanar reconstruction (MPR) of the dynamic T1 subtraction sequence. (B) Access route and biopsy angle. (C) Perpendicular distance from the pectoralis major muscle to the lesion in T1-weighted with spectral attenuated inversion recovery (SPAIR) sequence.
Illustration of the measurements. (A) In blue, the distance from the lesion to the nipple. A circle was drawn around the target lesion to capture the proportion of the surrounding mammary gland. These measurements were taken after multiplanar reconstruction (MPR) of the dynamic T1 subtraction sequence. (B) Access route and biopsy angle. (C) Perpendicular distance from the pectoralis major muscle to the lesion in T1-weighted with spectral attenuated inversion recovery (SPAIR) sequence.

FIGURE 4.

Histological findings of breast biopsies. ADH = atypical ductal hyperplasia; DCIS; ductal carcinoma in situ; FEA = flat epithelial cell atypia; ILC = invasive lobular carcinoma; LCIS = lobular carcinoma in situ; LIN = lobular intraepithelial neoplasia; NST = non-special type
Histological findings of breast biopsies. ADH = atypical ductal hyperplasia; DCIS; ductal carcinoma in situ; FEA = flat epithelial cell atypia; ILC = invasive lobular carcinoma; LCIS = lobular carcinoma in situ; LIN = lobular intraepithelial neoplasia; NST = non-special type

Univariate analysis for relatively larger hematoma with patient demographics and lesion characteristics

Survey of breast biopsies
Parameter All (n=252) Relatively smaller hematoma (n = 200) Relatively larger hematoma (n = 52) P Value
Age (y) 51.96 ±11.69 53.09 ±11.09 47.63 ±12.984 0.002*
Procedure time (min) 41.83 ±13.39 42.58 ±13.80 38.96 ±11.324 0.072
Right biopsy side 117 46% 90 45% 27 52% 0.436
Number of samples 12.08 ± 4 11.81 ±4.08 13.1 ±3.533 0.243
Biopsy system 0.035*
  VABB 228 90% 177 88.5% 51 98%
  Spirotome 24 10% 23 11.5% 1 2%
LAE 171 68% 133 67% 38 73% 0.408
Lesion size (mm) 11.2 ±6.612 11.27 ±6.55 10.94 ±6.89 0.425
Distance LN in RBV 0.079 ± 0.05 0.07 ± 0.04 0.11 ±0.04 0.001*
Access path length in RBV 0.055 ± 0.046 0.05 ± 0.03 0.08 ±0.07 0.001*
PDPectLesion in RBV 0.065 ± 0.036 0.06 ± 0.04 0.07 ± 0.04 0.143
Biopsy angle (degree) 90.79 ± 10.4 90.93 ± 9.55 90.27 ± 13.26 0.443
Pathological findings 0.831
  Benignity 159 63% 125 63% 34 65%
  highrisk lesions 36 14% 28 14% 8 15%
  Malignancy 57 23% 47 24% 10 19%
Pretreatment 65 26% 55 28% 10 19% 0.286
Lesion location 0.399
  Upper inner q 47 19% 34 17% 13 25%
  Upper outer q 84 33% 64 32% 20 38%
  Lower inner q 24 10% 21 11% 3 6%
  Lower outer q 72 29% 61 31% 11 21%
  Areolar 25 10% 20 10% 5 10%
Proportion of mammary gland 0.215
  0–25% 105 42% 85 43% 20 38%
  25–50% 48 19% 37 19% 11 21%
  50–75% 47 19% 37 19% 10 19%
  75–100% 52 21% 41 21% 11 21%

Results of multivariate logistic regression analysis for relatively larger hematoma

B S.E. Wald test df P value Odds ratio 95% CI
Variable - +
Age (y) -0.031 0.160 3.927 1 0.048* 0.969 0.94 1
Biopsy system 2.468 1.11 4.947 1 0.026* 11.798 1.341 103.811
Distance LN in RBV 9.501 3.538 7.214 1 0.007* 13379 13.037 13.7 × 10^6
Access path length in RBV 7.622 3.49 4.77 1 0.029* 2043 2.186 1.9 × 10^6
Procedure time (min) -0.025 0.015 2.759 1 0.097 0.975 0.947 1.005
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