Breast Biopsy and Breast MRI Wire Localization

Breast MRI guided intervention has become an increasingly important technique for breast radiologists largely due to increasing diagnostic breast MRI examination volumes. Alongside this there has been improved diagnostic image quality with a resulting number of breast lesions detected only on MRI requiring further clarification. International guidelines now insist that institutions performing breast MRI should provide the option of an MRI-guided intervention for further lesional work up, whether in their own unit or at a local center that can be referred to. This chapter covers the indications for these interventions, in particular which lesions require biopsy and when a lesion can just be managed with imaging follow up. Technical aspects are considered such as MRI scanner hardware and software requirements, as well as which biopsy needles are most appropriate. Limitations and complications are covered including “tips and tricks” that may be of use in certain specific clinical situations. Outcomes of MRI-guided biopsies are discussed based on current literature with a final view taken on future directions.