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The aim of this study was to evaluate the effort, accuracy, histological diagnoses and value of MR-guided vacuum biopsy (10-gauge, 9-gauge) as the diagnostic procedure for suspicious breast lesions visible on MRI alone. 389 MR-guided vacuum biopsies of suspicious MRM findings were performed in 365 patients either with a Vacora system (10G, Bard Company) or an ATEC system (9G, Suros Company). The retrospective study included the number of specimens, the table time, the complication rate, and the histopathological results for open biopsy and the findings after follow-up. The study included 341 unilateral unilocular, 12 unilateral bilocular and 12 bilateral unilocular MR-guided vacuum biopsies. In 27 patients (3.9%) the planned intervention was canceled because the lesion could not be reproduced. The average number of specimens was 15.1 (range 4 - 75) with the 10G technique and 14.6 (range 4 - 38) with the 9G technique. The table time was 43.2 min (range 17 - 95 min). Histology revealed concordant benign lesions in 231 cases (59.4%), borderline lesions in 50 cases (12.8%), malignant tumors in 106 cases (DCIS 30 [7.7%], invasive carcinoma 76 [19.5%]), and discordant findings in 2 cases (0.5%). The complication rate was less than 1%. MR-guided vacuum biopsy of the breast is an effective method for the minimally invasive percutaneous evaluation of suspicious breast lesions seen on MRI alone. As a consequence, primary open biopsy can be avoided and the rate of unnecessary surgical interventions reduced. There were no major differences between 10G and 9G vacuum biopsy systems.

Preoperative MRI of the breasts has been proven to be the most sensitive imaging modality in the detection of multifocal or multicentric tumor manifestations as well as simultaneous contralateral breast cancer. The aim of the presented retrospective study was to evaluate the benefit of preoperative MRI for patients with breast cancer. Preoperative MRI performed in 121 patients (group A) were compared to 225 patients without preoperative MRI (group B). Patients of group A underwent contrast-enhanced MR imaging of the breast using a 2D FLASH sequence technique (TR/TE/FA 336 ms/5 ms/90 degrees; 32 slices of 4-mm thickness, time of acquisition 1:27 min, contrast agent dosage 0.1 mmol Gd-DTPA/kg bw). All patients had histologically verified breast cancer and follow-up for more than 20 months (mean time group A: 40.3 months, group B: 41 months). Both groups received the same types of systemic treatment after breast conserving surgery. The in-breast tumor recurrence rate in group A was 1/86 (1.2%) compared to 9/133 (6.8%) in group B. Contralateral carcinoma were detected within follow-up in 2/121 (1.7%) in group A vs. 9/225 (4%) in group B. All results were statistically significant (P0.001). Based on these results, preoperative MRI of the breasts is recommended in patients with histopathologically verified breast cancer for local staging.

Ziel. Umsetzung qualitatsverbessernder Masnahmen in der rontgendiagnostischen Abteilung einer universitaren Einrichtung zur Verbesserung der internen Handlungsablaufe sowie der Kontakte im Bereich von Schnittstellen (Patient, Zuweiser, MTRA, Radiologe). Methodik. Nach der Durchfuhrung von Vorgesprachen und Vorstudien erfolgten durch einen Berater moderierte halbtagige Workshops zu den Themen “Verhalten gegenuber Patienten”, “Befunderstellung und Verhaltnis zu den Uberweisern” sowie “Forschung und Ausbildung”. Es wurden Veranderungsmasnahmen zum Abbau der wichtigsten Qualitatshemmnisse in verschiedenen Handlungsfeldern definiert und noch im Workshop durch den Abteilungsleiter entschieden. Ergebnisse. In 8 Behandlungsfeldern wurden insgesamt 53 Masnahmen beschlossen, die jeweils von einem Verantwortlichen innerhalb einer definierten Frist umzusetzen waren. Nach 6 Monaten waren 46 (86%) dieser Masnahmen komplett realisiert und weitere 4 (8%) innerhalb noch laufender Fristen in Bearbeitung. Anhand einer Patienten- und Zuweiserumfrage konnte die Zufriedenheit z. B. im Hinblick auf den Umgang mit Wartezeit bzw. Befunderstellung partiell gesteigert werden. Schlussfolgerungen. Die Durchfuhrung qualitatsverbessernder Masnahmen in einer radiologischen Abteilung fuhrt zu einer deutlichen Verbesserung der internen Betriebsablaufe und z. T. auch der externen Kommunikation. Essentielle Bestandteile einer solchen Optimierung sind die Unterstutzung durch einen abteilungsexternen Berater sowie eine konsequente Kontrolle der Umsetzungserfolge.