209 - Pearls and Pitfalls for Tomosynthesis-Guided Procedures

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