Innovative strategies for minimizing hematoma risk in MRI-guided breast biopsies.

Background: The study aimed to investigate the reduction of hematoma risk during MRI-guided breast biopsies by evaluating position-dependent intervention parameters and characteristics of the target lesion.

Materials and methods: We retrospectively analyzed 252 percutaneous MRI-guided breast biopsies performed at a single center between January 2013 and December 2023. Two groups were built depending on the severity of relative hematoma formation (using a cut-off ≤ 7.62 cm³ or > 7.62 cm³). Potential influencing variables were assessed, such as patient demographics, interventional parameters related to anatomical landmarks, and lesion characteristics. Fisher's exact test and Mann-Whitney-U-Test were used to calculate the statistical difference between groups of categorical, dichotomous, and continuous variables. Multivariable logistic regression was used to identify the strongest association with relative hematoma formation.

Results: The univariate analysis showed that relatively larger hematoma occurred significantly more frequently when the patients were younger (P = 0.002), the relative distances from the target lesion to the nipple (P = 0.001) as well as alongside the access path (P = 0.001) were greater and when the vacuum-assisted biopsy system was used in contrast to the Spirotome® (P = 0.035). Multivariable logistic regression analysis also showed that these were independently associated with the occurrence of relatively larger hematomas. Epinephrine in the local anesthetic, lesion location classified by specific quadrant, and pathological findings did not influence the extent of the hematoma.

Conclusions: Our findings underscore the importance of strategic procedural planning to minimize hematoma occurrence and enhance patient safety during MRI-guided breast biopsy procedures.