Stereotactic Histologic Biopsy with Patients Prone: Technical Feasibility in 98% of Mammographically Detected Lesions

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Stereotactic Histologic Biopsy with Patients Prone: Technical Feasibility in 98% of Mammographically Detected Lesions

Roger J. Jackman¹ and Francis A. Marzoni, Jr.²

^¹ Radiology Department, Palo Alto Medical Clinic, 795 El Camino Real, Palo Alto, CA 94301.
^² Surgery Department, Palo Alto Medical Clinic, Palo Alto, CA 94301.

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Fig. 1A. —Sponge used to simulate breast with patient in prone position on Fischer table (Fischer Imaging, Denver, CO) being maximally compressed by front compression paddle (FCP) in two different ways. Photograph shows minimal sponge thickness (1.9 cm) achieved by hand pressure flattening front of sponge to minimize sponge protrusion through 5 x 5 cm aperture in FCP while back of sponge is compressed against digital image receptor (DIR).

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Fig. 1B. —Sponge used to simulate breast with patient in prone position on Fischer table (Fischer Imaging, Denver, CO) being maximally compressed by front compression paddle (FCP) in two different ways. Photograph shows maximal sponge thickness (3.8 cm) achieved by combination of air-gap technique (with reversed back compression paddle [BCP]) and hand pressure around periphery of sponge (between FCP and BCP) to maximize sponge protrusion through apertures in FCP and BCP. With this air-gap technique, back of sponge is compressed against BCP rather than DIR.

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Fig. 2A. —Converse skin hook (Storz Surgical Instruments, St. Louis, MO) used to stabilize breast tissue during needle insertion and to increase breast thickness during biopsy of lesions in thin breasts. Photograph shows full view of 186-mm-long hook.

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Fig. 2B. —Converse skin hook (Storz Surgical Instruments, St. Louis, MO) used to stabilize breast tissue during needle insertion and to increase breast thickness during biopsy of lesions in thin breasts. Magnified photograph shows hook end that is inserted into skin nick.

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Fig. 3A. —67-year-old woman with impalpable lesion in right breast who had stereotactic biopsy that was initially canceled and later successfully completed. Craniocaudal mammogram of right breast obtained before canceled biopsy shows 4-mm, indistinct, Breast Imaging Reporting and Data System (BI-RADS) [9] category 4 density (arrow) in lateral aspect of breast. Density was not visible on oblique or lateral mammograms (not shown).

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Fig. 3B. —67-year-old woman with impalpable lesion in right breast who had stereotactic biopsy that was initially canceled and later successfully completed. Craniocaudal scout mammogram of right breast obtained with patient in prone position reveals density (arrow) inadequately to proceed with biopsy. Density was not visible on 15° oblique stereotactic images (not shown). BI-RADS category was revised to 3 after canceled biopsy.

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Fig. 3C. —67-year-old woman with impalpable lesion in right breast who had stereotactic biopsy that was initially canceled and later successfully completed. Craniocaudal mammogram of right breast obtained 8 months after A and B and before biopsy was completed shows 8-mm, minimally spiculated, BI-RADS category 4 mass (arrow) in lateral aspect of breast. Mass is now visible in upper aspect of breast on oblique and lateral mammograms (not shown) but was not visible on sonography (not shown). Pathologic results of stereotactic biopsy revealed invasive ductal carcinoma and ductal carcinoma in situ (not shown).

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