Background: Image-guided biopsy is important to the diagnosis of suspicious breast lesions. Approximately 1 million breast biopsies are performed each year in the United States (1). While the majority of cases are straightforward, certain cases can be particularly challenging and require careful planning and creative approaches to successfully biopsy the target. Breast imagers should be cognizant of patient, anatomical and technical factors that predispose to a potentially difficult stereotactic and DBT-guided breast biopsy. The purpose of this educational exhibit is to demonstrate practical techniques and tools to safely and successfully biopsy breast lesions in difficult scenarios.
Learning Objectives: Completing this educational exhibit will allow participants to 1) Appreciate lesion conspicuity and location predisposing to difficult stereotactic/DBT-guided breast biopsies 2) Recognize pre-procedural planning, techniques and tools to optimize lesion visualization, targeting and sampling 3) Implement this knowledge to minimize stereotactic/DBT cancellations, unsafe and/or nondiagnostic procedures.
Abstract Content/Results: This case-based exhibit will demonstrate procedural planning and tips for successful difficult-to-perform stereotactic and DBT-guided breast biopsies including: (1) inspecting breast architecture/tissue landmarks to locate target for sampling. (2) using FFDM images with skin markers to position the target in the grid. (3) use 5K diagnostic monitors for hard-to-see targets. (4) retarget if lesion obscured by lidocaine injection or probe placement. (5) compare Scout/Pre-fire/post-fire DBT target depths on scroll bar. (6) for vague targets: position target closer to the edge of the compression paddle window, utilize optimal compression to visualize target (Opsite® for more optimal tissue compression in the paddle window if needed). (7) superficial targets: inject more lidocaine to create more “depth”, advance the center of the sampling aperture beyond the target to not sample skin, place mark on skin over target, and biopsy by US (8) very thin breast: apply skin hook to pull skin over the sampling aperture, tape a second compression paddle with biopsy window to the detector to allow tissue to extend posterior to the target, take advantage of using the petite needle, and consider lateral arm approach. (9) posterior target: consider CC versus LM projection, upright versus prone table, arm-through-table-hole technique. We will provide summary and take-home points to facilitate transfer of knowledge.
Conclusion: Stereotactic and DBT-guided breast biopsy can be feasible, safe and diagnostically accurate for difficult targets, with proper planning and utilization of additional techniques and tools.
