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Stereotactic Biopsy of the Breast Using an Upright Unit, a Vacuum-Suction Needle, and a Lateral Arm-Support System

¹ Department of Radiology, University of Washington Medical Center, Box 375115, 1959 N. E. Pacific, Seattle, WA 98195.
² Present address: Department of Radiology, Massachusetts General Hospital, Wang ACC 219-Q, 15 Parkman St., Boston, MA 02114.
³ Department of Radiology, University of Massachusetts Memorial Medical Center, Rm. 2144, 55 Lake Ave. N., Worcester, MA 01655.
⁴ Department of Radiology, South Shore Hospital, 55 Fogg Rd., South Weymouth, MA 02190.
⁵ Department of Radiology, Travis Air Force Base, CA 94535-1800.

OBJECTIVE. This study evaluated the vacuum-suction needle (8- to 11-gauge) on an upright stereotactic machine with a lateral arm-support system.

SUBJECTS AND METHODS. From July 1999 to August 2000, 185 core biopsies of the breast in 179 consecutive patients were planned in four institutions using 8- 11-gauge vaccum-suction probes on an upright stereotactic unit. Needles were stabilized and attached to the x, y, and z coordinates of the machines via a lateral arm-support system. Needle entry was made in the x-axis.

RESULTS. Five patients were canceled, and 180 biopsies were performed in 174 patients while the patients were in seated (n = 171) and lateral decubitus (n = 9) positions. An average of 9.5 cores were taken (range, 5-26 cores). Targeting was successful in 176 (98%) of 180 cores. Lesions were missed because of movement associated with Parkinson's disease (n = 1), or because the mass was obscured (n = 1) or calcifications were not in the core specimen (n = 2). Findings in 152 (84%) of the biopsies were benign and 28 (16%) were malignant. Forty-one lesions underwent surgical excision and 106 underwent mammographic follow-up. Discordance was 4% (6/147). Complications included vasovagal reactions (n = 10, 5.6%), bleeding (n = 5, 3%), hematomas (n = 3, 1.7%), vomiting (n = 1, 0.6%), and technical failure (n = 1, 0.6%).

CONCLUSION. Vacuum-suction needle core biopsies can be successfully performed on an upright stereotactic machine with a lateral arm attachment. Thinly compressed breasts and lesions located near the chest wall are well sampled. The vasovagal rate is higher than that on a prone table but is acceptable.

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