Introduction The purpose of this study was to correlate the pathology results of magnetic resonance imaging (MRI)-guided breast biopsies at our institution to MRI findings and patient clinical history characteristics. t-test. Results Two-hundred fifteen lesions in 168 patients were included of which 23 (10.7%) were malignant 43 (20%) were high risk and 149 (69.3%) were benign. No clinical characteristic was associated with malignancy in our cohort. MRI features associated with malignancy were: larger size (mean 2.6 cm versus 1.3 cm p=0.046) washout kinetics (18% malignancy rate p=0.02) and marked background parenchymal enhancement (40% malignancy rate p-value <0.001 to 0.03). Nineteen (28%) of the 67 patients with a new diagnosis of breast cancer undergoing MRI-guided breast biopsy had a change in surgical management based on the biopsy result. Conclusions Malignancy rate was associated with lesion size washout kinetics and marked background enhancement of the breast parenchyma ABT-751 but was not associated with any clinical history characteristics. Pre-operative MRI-guided breast biopsies changed surgical management in 28% of women with a new diagnosis of breast cancer. Introduction Breast magnetic resonance imaging (MRI) is commonly used for breast cancer screening in high risk patients and to evaluate the extent of disease in patients with a new diagnosis of breast cancer. Although MRI has a high reported sensitivity for breast cancer of 0.90 (95% confidence interval: 0.88 0.92 it has a lower specificity of 0.72 (95% confidence interval: 0.67 0.77 and biopsy is often required to establish a diagnosis.1 2 When a suspicious lesion is visible only on MRI MRI-guided biopsy is a fast and safe option for diagnosis. The reported malignancy rate of MRI-guided breast biopsies varies from 18 to 60% with most studies reporting malignancy rates of 20-35%.3-11 The variation is probably related to differences in patient populations study designs and radiologist thresholds for recommending biopsy. Per the American College of Radiology BI-RADS Atlas 2013 the benchmark for the malignancy rate of MRI-guided biopsies performed (also known as the biopsy yield of malignancy or positive predictive value 3 (PPV3)) ABT-751 is 20-50%.12 MRI-guided breast biopsies are often performed in women with a new diagnosis of breast cancer although the role of breast MRI in this patient population is controversial. While several studies have demonstrated that pre-operative breast MRI changes surgical management in 10-34% 13 some argue that this change in surgical plan does not change patient outcomes.18-20 Additional studies evaluating the role of breast MRI in this patient population and its subsequent clinical impact are needed. The purpose of this study was to correlate the pathology Rabbit Polyclonal to RXFP2. results of magnetic resonance imaging (MRI)-guided breast biopsies at our institution to MRI findings and patient clinical history characteristics. The impact of MRI-guided breast biopsies on surgical management in patients with a new diagnosis of breast cancer was also assessed. Patients and Methods Subjects This HIPAA-compliant study was approved by the Institutional Review Board at Johns Hopkins Hospital. A database search for all MRI-guided breast biopsy exams from March 2006 to May 2012 was performed which identified 261 potentially eligible lesions. In order to be eligible lesions must have been successfully biopsied by MRI-guidance (MRI-guided core biopsy or MRI-guided localization with subsequent surgical biopsy) have available images from the MRI exam on which the biopsy was recommended and have available pathology results. Forty-six lesions were excluded for the following reasons: images were from an MRI-guided biopsy performed at an ABT-751 outside institution (n=15) biopsied lesions were identified on outside images which were not available (n=15) procedure was MRI-guided clip placement ABT-751 without direct pathology (n=6) unsuccessful biopsy attempts (n=6) or exams of localizations for known cancers or lesions which had already undergone biopsy (n=4). This study included suspicious BIRADS-4 or 5 lesions that were only visualized by MRI. Therefore suspicious lesions detected by MRI for which second look ultrasound and subsequent ultrasound guided biopsy were performed were excluded. For the 215 eligible lesions the original breast MRI which identified the suspicious lesion undergoing MRI-guided breast biopsy was then.