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So challenge number 13.

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This is a patient who, on her diagnostic study,

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here's the post GAD image and here is the subtraction image.

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So she had clumped linear enhancement.

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So this is pretty concerning for non mass enhancement.

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You know, you're, you're pretty worried that's going to be,

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um, DCIS.

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Here's her post biopsy MR Study.

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You can see she's got air in the cavity here, a little bit

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of hemorrhage or fluid up here.

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And it looks like the sampling was

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really, you know, pretty good.

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It looks like it was in the right place,

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and yet this came back as being fibrocystic change.

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So the question is, is it a non concordant biopsy or not?

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Um, when they've done studies, there's actually some kind

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of frightening figures out there for guided biopsies

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and they have shown that, uh, up to 15%, 14% of lesions

0:51

that are targeted are inadequately sampled.

0:53

If you do a follow-up gadolinium enhanced MR study,

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and this has come from a couple of studies,

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so in other words, you think you've got it,

1:00

you're completely happy with it, you think it's concordant,

1:03

you do a follow-up study and no, you haven't,

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whether it's benign or malignant.

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And overall the amount of false negative

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MR guided biopsies is 2.5%, which is significantly higher

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than it is for stereo tactical and ultrasound guided biopsy.

1:19

So if you get a result

1:20

that you are concerned may be discordant

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and you do the same rad path correlation you do with,

1:25

you know, anything else that we biopsy, any other way

1:27

that we biopsy in breast imaging, the first thing you want

1:30

to do is check the adequacy of your biopsy.

1:32

So look back, look at where the cavity was compared to your,

1:37

um, prebi gadolinium enhanced study.

1:40

Look at where the clip is on the post mammogram

1:43

and then depending on how concerned about it,

1:46

you could do a couple of different things.

1:47

You could do a short interval follow up

1:49

and I wouldn't really wait six to months

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unless you have very low concern about this lesion.

1:56

I think six to eight weeks is the

1:57

more appropriate follow up.

1:59

You can then take them back

2:00

and re-biopsy them if, um, you see

2:03

that the lesion is still there

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and you could set them up for a, um,

2:07

diagnostic slash biopsy slots, you already

2:10

to go in one go if you wish.

2:12

At that point, um, you could take them back

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and do an MR guided needle lo at the lesion,

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or you could do a regular mammographic needle lo using

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the clip placed in biopsy.

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If you consider that that is in the right position

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and probably getting the surgeon to be reasonably generous

2:28

with their biopsies.