209 - Pearls and Pitfalls for Tomosynthesis-Guided Procedures
Friday, April 3, 2020
2:00 PM – 2:30 PM
Location: LinQ - Social C
Background: Needle Core Biopsy Needle core biopsy has proven its benefit safe, accurate and less invasive alternative to surgical excision, as well as more cost-effective for the patient Considered “best practice” for mammographically detected abnormalities
Background: DBT Increased breast cancer detection Decreased recall rates for non-cancer cases Improved lesion margin visibility Precise lesion location Better visualization of architectural distortion (A/D)
Use of DBT DBT use in clinical practice continues to grow; nationally as of October 2018, there are more than 4,700 certified facilities with DBT units, and more than 6,600 accredited DBT units DBT is being utilized in all practice types, and in a variety of exam and patient indications Scenarios exist in which a suspicious lesion is identified only on DBT, without an US correlate, creating a management dilemma = need for tomosynthesis-guided core biopsy
DBT Guided Biopsy Why is it needed? Preferable to biopsy under guidance of modality that best demonstrates lesion DBT has shown to better depict certain lesion types (i.e. architectural distortion), giving rise to “DBT only” findings
Biopsy Process DBT Guided Biopsy Options DBT Guided Biopsy (prone) Procedure Patient positioned prone on the biopsy table, and the lesion is (ideally) centered in the biopsy window with the shortest skin to lesion distance Scout image is acquired, and on the screen, the user scrolls through the images to identify the appropriate image slice of the lesion to be biopsied X, Y and Z values will automatically appear once lesion is clicked; this will create the target for the procedure to move forward process replaces the traditional targeting for stereo biopsy, which requires the scout and stereo pair images to identify the z DBT Biopsy Procedure Tech can see the coordinates selected before proceeding with the procedure Once the biopsy needle is in place, the tomosynthesis pre-fire image is acquired important to scroll through to verify the needle is positioned accurately at the lesion of interest also allows for time to make any necessary needle adjustments
DBT Biopsy Sampling of the lesion as is done traditionally, as well as for the clip placement, and specimen imaging (if applicable) A post-fire image is obtained; again, the user can scroll through the projection images to identify the lesion and ensure accurate sampling
Upright System Advantages Prone System Advantages DBT-Guided Biopsy Disadvantages
Tips and Tricks
Summary DBT-guided biopsy is a feasible method to incorporate, and has proven technical success Comparable if not improved performance for different lesion types Ability to provide definitive diagnosis for abnormalities identified only with DBT
Upon completion, participant will be able to identify clinical scenarios necessitating the need to perform tomosynthesis-guided biopsy, or localization
Upon completion, participant will be able to describe current available methods for clinical implementation.
Upon completion, participant will be able to understand tips and tricks for tomosynthesis-guided procedures.