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DOI:10.2214/AJR.07.2436
AJR 2008; 190:W270
© American Roentgen Ray Society

Lesions Too Close to the Chest Wall: A Relative Contraindication for Vacuum-Assisted Breast Biopsy

Flora Zagouri, Theodoros N. Sergentanis and George C. Zografos

Hippokratio Hospital University of Athens Athens, Greece
School of Medicine University of Athens Athens, Greece



 
WEB—This is a Web exclusive article.

Vacuum-assisted breast biopsy is a minimally invasive technique with ever-growing use for the diagnosis of mammographically detected, nonpalpable breast lesions. This tech nique can be mammographically, sonographically, or MRI guided [1]. However, not all breast lesions can be sampled by vacuum-assisted breast biopsy. For instance, proximity of a lesion to the chest wall has been described as a factor inhibiting the accomplishment of the stereotactic biopsy [2].

In this letter, we present our experience with a modified way of performing stereo tactic 11-gauge vacuum-assisted breast biopsy (with the patient prone on the Fischer's table) on lesions in proximity to the chest wall. During a 19-month period (September 2005–March 2007), 38 lesions in proximity to the chest wall were sampled. It is worth mentioning that there has been no case of failure since the adoption of the modifications described for this procedure.

The important steps of the modified procedure are the following. First: the plastic paddle should be removed from the Fischer's table. Second: the arm ipsilateral to the breast to be biopsied should be stretched on and along the patient's back (normally the hand lies at the side of the patient). During positioning of the patient, force should be exerted onto the shoulder toward the aperture of the Fischer' table where the breast is hanging (Fig. 1). Third: to assure the stability of the arm, the woman should be informed about the problem and the modified biopsy procedure and should be encouraged to stay immobile. Fourth: the corners of the aperture of the compression paddle should be marked on the patient's skin with a pen to ensure the immobility of the patient.


Figure 1
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  		Fig. 1 —Patient with lesion in proximity to chest wall. Photograph shows positioning of patient on Fisher's table.

 


Figure 2
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  		Fig. 2 —Details of lesion in proximity to chest wall seen on vacuum-assisted breast biopsy screen.

 
In conclusion, lesions in proximity to the chest wall seem not to constitute an absolute contraindication of vacuum-assisted breast biopsy (Fig. 2).


References
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 References
 

  1. Liberman L, Bracero N, Morris E, Thornton C, Dershaw DD. MRI-guided 9-gauge vacuum-assisted breast biopsy: initial clinical experience. AJR 2005; 185:183 -193[Abstract/Free Full Text]
  2. Jackman RJ, Marzoni FA Jr. Stereotactic histologic biopsy with patients prone: technical feasibility in 98% of mammographically detected lesions. AJR 2003;180 : 785-794[Abstract/Free Full Text]

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