With growing adoption of digital breast tomosynthesis, an increasing number of imaging abnormalities are being identified only by tomosynthesis. Upright digital breast tomosynthesis-guided stereotactic biopsy is a proven method for sampling these abnormalities as well as abnormalities traditionally evaluated using conventional stereotactic biopsy. In this article, we describe the technique of upright digital breast tomosynthesis-guided stereotactic biopsy and outline a systematic operational approach to implementation of this technique in clinical radiology practices.
Introduction
Core needle biopsy is a widely accepted tissue-sampling method for the diagnosis of nonpalpable image-detected abnormalities. This procedure has been proven to be a safe, accurate, and cost-effective alternative to surgery for biopsy of suspicious image-detected lesions . Core needle biopsy most often is performed with ultrasound, stereotactic, or magnetic resonance imaging guidance.
Digital breast tomosynthesis (DBT) is a useful supplement to full-field digital mammography (FFDM) that addresses some of the limitations of conventional FFDM. Compared to FFDM alone, FFDM plus DBT has been shown to increase the cancer detection rate, detect smaller cancers, and reduce the rate of false-positive findings and associated call-backs; FFDM plus DBT has been particularly beneficial in evaluation of patients with dense breasts . Mass morphology and architectural distortion are often better visualized and characterized by DBT than by FFDM because with DBT there is less obscuration by overlapping breast tissue .
Radiologists need image-guided biopsy techniques to diagnose imaging abnormalities visible only on DBT . In one study of DBT-guided localization of lesions without sonographic or magnetic resonance imaging correlate, although DBT-only lesions comprised 3% of screening and diagnostic cases, 47% of these cases were malignant and 14% were high-risk lesions .
At our facility, noncalcified abnormalities detected by DBT are first evaluated by sonography for further characterization and biopsy planning. For lesions without an ultrasound correlate, we perform DBT-guided biopsy. All of our stereotactic biopsies, including biopsies of calcifications, are performed using DBT guidance as we do not have a separate conventional FFDM stereotactic biopsy unit. We have performed hundreds of successful stereotactic biopsies using DBT-guided biopsy.
Currently, both private-practice and academic radiology practices are pursuing DBT-guided biopsy technology. To assist other radiology practices, we review here the DBT-guided biopsy technique and describe a systematic approach to implementation of upright DBT-guided biopsy in radiology practices.
Technique for DBT-Guided Biopsy
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Steps Toward Implementation of DBT-guided Biopsy in a Radiology Practice
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Evaluation of Current Practice
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Product Evaluation and Acquisition
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Personnel Training
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Integration of DBT-guided Biopsy Into the Existing Workflow
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Patient Selection for DBT-guided Biopsy
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Conclusions
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