Februaury 2009

The first MR guided breast biopsy in India : Dr. A. Jena, Chief of MRI, Rajiv Gandhi Cancer Institute & Research Centre and Dr. Sangeeta Taneja, Radiologist, MRI Department, Rajiv Gandhi Cancer Institute & Research Centre

Rajiv Gandhi Cancer Institute and Research center, India has taken yet another quantum leap by conducting the first MR guided breast biopsy on 15 December 2008 in the country. The dedicated team of trained professionals with high-end MRI machine and now the facility to do Breast Biopsy under MR guidance, the department of MRI has launched its world class MR mammography program to boost the existing breast cancer care under one roof in the institute. Spearheading the team with Dr Jena, Chief of MRI and a pioneering figure in MRI in the country, is Dr Sangeeta Taneja, a promising young Radiologist and experienced MR specialist who received advanced training on MR Guided Breast Biopsy in Seattle Cancer Care Center and Washington University under prominent luminaries in the field like Dr. Lehman C and Dr. Bruce Porter to carry the program to success.

MR Mammography is a safe and powerful imaging technique that detects lesions, as small as 2-3 mm without the use of radiation. With its capability to detect cancer in almost 100 per cent cases, it makes for the best early detection tool for breast cancer, which, if removed results in cure. It is often so, that many of these are “only MR detected lesions” i.e. not seen on conventional modalities like mammography (x-ray) or ultrasound for biopsy. So far, such suspicious cancer foci, which usually pose anxiety to both the patient and the treating doctor, were only left up to follow-up when they could actually be dealt with through biopsy under MR guidance – a popular and routine practice in the west. The procedure was not available till now in India and our patients were either denied such need or they had to go abroad to seek help. Now that we have MR guided biopsy facility at hand the whole spectrum of breast lesions can be appropriately addressed.

In about 7 per cent of cases of known breast cancer, it harbours additional lesions in the affected or contra lateral normal breast, a finding that significantly influences an important decision like breast conservation vs. mastectomy.

 

 

In about 7 per cent of cases of known breast cancer, it harbours additional lesions in the affected or contra lateral normal breast, a finding that significantly influences an important decision like breast conservation vs. mastectomy.Some of these unexpected lesions may require biopsy under MR guidance for histological proof for accurate local staging. We have found it beneficial like many leading cancer centres in the world to include MR mammography in the routine pre-surgery work up of cases to depict the true extent of the lesion in general and in those scheduled for breast conservation in particular. Besides this, breast biopsy under MR guidance is going to play an important role along with MR mammography in exclusively addressing issues like recurrence versus scarring due to surgery/radiation therapy, benign and malignant causes of nipple discharge or cancer in implanted breast. In these areas, MR guided biopsy can promptly allay any anxiety by providing a quick and reliable answer as regards the nature of the lesion.

Fig 1: MRI system with Dual breast coil and biopsy device in position

MRI has been reported to detect smaller and more cancers in high risk population (BRCA mutations, family history of breast cancers etc.) as also a number of unsuspected indeterminate lesions, during MR mammography done with well-defined indications like search for breast primary etc. The American Cancer Society (ACS) in 2007 has recommended the use of MR mammography as an adjunct screening modality for high-risk population. It is also added, by breast authorities, that for units practicing breast MRI to have MR guided breast biopsy facility as mandatory.

Fig 2: MR mammography done for extent uation in diagnosed case of cancer left breast reveals small (2.5 mm) “only MR detected” malignant lesion (histology proved) in contra lateral right breast This highlights the fact that MR does detect such early lesions, can help prove its nature through guided biopsy, which has altered the management as in this case and can be cured had it been the only detected lesion.

RGCI envisages providing the best breast care to the population with a dream to reduce the mortality due to breast cancer with early diagnosis and hence early treatment. Creation of a comprehensive ‘MR Mammography Program’ is a humble effort towards this direction. This pioneering effort will go a long way towards setting up of a dedicated breast care center in the country as has been the practice in any cancer care centre elsewhere in the world.

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