AJR 2001; 177:897-899
© American Roentgen Ray Society
Lateral Approach Biopsy Adapter
Accuracy on an Upright Unit in a Turkey Breast Model
Constance D. Lehman1,
Hilarie J. Sieler-Gutierrez2 and
Dianne Georgian-Smith2
1
Department of Radiology, University of Washington Medical Center, Seattle
Cancer Care Alliance, 825 Eastlake Ave. East, Mail Stop G4-830, Seattle, WA
98109.
2
Department of Radiology, University of Washington Medical Center, Box 357115,
HSB RR-215, 1959 N.E. Pacific St., Seattle, WA 98195-7115.
Received October 26, 2000;
accepted after revision March 28, 2001.
Presented at the annual meeting of the American Roentgen Ray Society,
Washington, DC, May 2000.
Address correspondence to C. D. Lehman.
Introduction
Vacuum-assisted breast biopsies have proven to be more advantageous than
14-gauge automated gun biopsies but have been limited, primarily being
performed on prone tables
[1,2,3,4,5,6,7].
Some institutions have not been able to offer vacuum-assisted breast biopsies
because of the high cost of a prone table or inadequate space available for
such a unit. A device now has been developed that allows vacuum-assisted
breast biopsy using an upright stereotactic unit. The device, called the
Lateral Approach Biopsy Adapter (General Electric Medical Systems, Milwaukee,
WI), accommodates either the Mammotome (Ethicon Endo-Surgery, Cincinnati, OH)
or the Minimally Invasive Breast Biopsy (U. S. Surgical, Norwalk, CT)
vacuum-assisted devices.
With the adapter, the biopsy puncture needle is introduced laterally into
the compressed breast, parallel to the compression paddle. The probe can be
fired before or after insertion into the breast. This method permits a wide
range of breast positioning, including craniocaudal, lateral, or oblique.
Biopsies may be performed from either the right or the left side of the biopsy
device and from medical or lateral and upper or lower aspects of the breast.
The patient may be in either a seated or recumbent position. The method of
performing recumbent biopsy using add-on upright equipment has been described
previously [8]. To date, no
reports on the accuracy of targeting or success in sampling with the Lateral
Approach Biopsy Adapter have been reported, to our knowledge.
Materials and Methods
We attached the Lateral Approach Biopsy Adapter to the digital upright
stereotactic biopsy add-on device for the Senographe DMR mammography system
(General Electric Medical Systems). For our study, we used the Minimally
Invasive Breast Biopsy vacuum-assisted device. Biopsies were performed on
turkey breasts with embedded olives with pimentos serving as phantom lesions.
The olives were 18 x 16 x 16 mm; the pimentos were 12 x 7
x 6 mm. The turkey breasts were compressed to a thickness of 1-3 cm for
each procedure. The distance from the lesion to the compression paddle and the
distance from the lesion to the support plate were recorded. For each of the
11 procedures, a scout image was obtained
(Fig. 1). The lesion was
targeted using stereotactic images obtained at +15° and -15°. The
x, y, and z coordinates were recorded (Fig.
2A,2B).
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Fig. 2A. —Paired stereotactic images obtained at different angles show
olive—pimento target marked. Stereotactic images were obtained at
+15° (A) and at -15° (B). Target coordinates: x
= 18.7 mm, y = 19.2 mm, z = 12.4 mm.
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The needle was introduced laterally into the compressed phantom breast,
parallel to the compression paddle, and the probe was advanced to a prefire
position, with the chamber center 2 cm proximal to the target. The correct
placement was determined by a stereotactic computer program (General Electric
Medical Systems) that provides the coordinates for placing the center of the
probe in its correct prefire position so that the chamber is 2 cm from the
target. The program we used also gives the operator the flexibility to
designate the specific needle or probe used, and the coordinates given for the
prefire probe or needle position make allowance for the throw of the specific
probe or needle used. Prefire stereotactic images were obtained, and x,
y, and z coordinates were recorded with the needle tip in the
prefire position (Fig.
3A,3B).
The probe was deployed, and stereotactic images were obtained. The x,
y, and z coordinates were recorded for the postfire chamber
center (Fig.
4A,4B).
Differences between the coordinates of each of the targeted lesions and
postfire chamber center were calculated, and core samples were obtained from
each lesion. A successful biopsy was defined as presence of pimento in the
core sample.
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Fig. 3A. —Paired stereotactic images obtained at different angles show
tip of needle at target before biopsy. Sterotactic images were obtained at
+15° (A) and at -15° (B). Needle coordinates: x
= 20.0 mm, y = 19.9 mm, z = 12.5 mm.
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Fig. 4A. —Paired stereotactic images obtained at different angles show
center of needle chamber in olive—pimento target after biopsy.
Stereotactic images were obtained at +15° (A) and at -15°
(B). Center of chamber coordinates: x = 19.0 mm, y =
20.2 mm, z = 13.6 mm.
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Results
All biopsies were successful; all core samples retrieved contained the
targeted pimento. The mean difference for all coordinates between the targeted
lesion and chamber center was less than 1 mm. Calculated means and ranges of
differences between the target and the chamber center were: x axis,
0.9 mm (range, 0-2.8 mm); y axis, 0.9 mm (range, 0.1-3.2 mm); and
z axis, 0.9 mm (0-2.3 mm). Targets that were sampled were as close as
5 mm to the compression paddle and as close as 5 mm to the support plate.
Discussion
Our in vitro study suggests the Lateral Approach Biopsy Adapter may allow
vacuum-assisted biopsy with an upright stereotactic biopsy add-on system. This
new method appears to permit accuracy in needle placement and target sampling,
with all biopsies (100%, or 11/11) being successful in our study. Therefore,
sites without dedicated prone stereotactic units may be able to use this
method for vacuum-assisted biopsies.
Most stereotactic breast biopsies are performed using dedicated prone
equipment. For many institutions, it is impractical to have a dedicated prone
stereotactic table for several reasons. Dedicated prone stereotactic tables
require a large amount of space in a radiology department; they are expensive;
and, most of the time, they remain unused because their sole function is to
provide guidance during the breast biopsy procedure. A stereotactic device
that can be added on to existing mammography units eliminates these
restrictions: Such a device requires no additional space in a radiology
department; it is less expensive than the dedicated prone mammography units;
and, when a biopsy is not being performed, it can be used for routine
mammography.
Stereotactic biopsy performed on prone tables in women with thin breasts
can be challenging. Previous articles have described methods to successfully
perform stereotactic biopsy in women with thin breasts using compression
[9,
10]. The lateral approach we
describe also carries a potential advantage for women with thin breast tissue,
because the probe is inserted parallel to, rather than perpendicular to, the
plate.
This study has several important limitations. Most important, ours was an
in vitro study to test the feasibility of using the Lateral Approach Biopsy
Adapter for vacuum-assisted breast biopsy with an upright add-on system. In
clinical practice, most breast lesions are smaller and more difficult to
distinguish from adjacent breast tissue than the olive-and-pimento target we
used in our study. Whether success in this in vitro model will translate to
success in clinical practice has not been proven by our study. Although a
small number of patients have been biopsied successfully with this method, a
clinical study of a large number of patients would need to be performed before
such conclusions could be made.
In summary, this series shows the accuracy of targeting and sampling using
the Lateral Approach Biopsy Adapter for vacuum-assisted breast biopsy in
vitro. This method offers a potential advantage of performing vacuum-assisted
breast biopsy without the expense of a dedicated prone table. Further studies
to assess accuracy, successful biopsy rates, and complication rates are needed
if we are to compare this method with vacuum-assisted breast biopsy performed
on prone tables.
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Introduction
Materials and Methods
