Management of breast lesions detectable only on MRI

Breast MR imaging has become established as the most sensitive imaging method for diagnosing breast cancer. As a result of the increasing examination volume and improved image quality, the number of breast lesions detected only on MRI and requiring further clarification has risen in recent years. According to the S3-guideline "Diagnosis, Therapy, and Follow-Up of Breast Cancer" as revised in July 2012, institutions performing breast MRI should provide the option of an MRI-guided intervention for clarification. This review describes the indications, methods and results of MRI-guided interventions for the clarification of breast lesions only visible on MRI. Recent guidelines and study results are also addressed and alternative methods and pitfalls are presented.

▶ Up to 57 % of lesions originally visible only on MRI can be sonographically correlated and biopsied. ▶ MRI-guided intervention is necessary for the clarification of BI-RADS® 4 and 5 lesions detectable only on MRI ▶ MRI-guided vacuum-assisted breast biopsy should be preferentially used ▶ MRI-guided localization and surgical excision should be used if MRI-guided vacuum-assisted biopsy is not possible ▶ If BI-RADS® 4 and 5 findings visible only on MRI are not detectable on interventional MRI, a follow-up MRI should be performed within six months.