Digital Breast Tomosynthesis-guided Needle Breast Biopsy: A local Institutional Experience

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Authors (including presenting author) :
M Cheung, CSY Lo, WWM Lam, TPW Lam
Affiliation :
Department of Radiology, Queen Mary Hospital
Introduction :
Digital breast tomosynthesis (DBT) has gained favour in the field of screening and diagnostic mammography with multiple studies proving its superior diagnostic performance over 2D mammography alone. Having incorporated screening and diagnostic DBT into our standard clinical practice, we reviewed our experience with DBT-guided core biopsy of breast lesions and its clinical performance.
Objectives :
To retrospectively review our experience and clinical performance of digital breast tomosynthesis (DBT)-guided needle biopsy in sampling target breast lesions.
Methodology :
This was a retrospective analysis of women undergoing DBT-guided needle biopsy with suspected breast lesions detected on mammography for further histological correlation. We study the clinical performance of DBT-guided needle biopsy by looking at parameters including technical success, procedural time (planning and tissue sampling time), lesion type and characteristics, and complications during the period using the same mammography unit. Procedural times and average glandular dose (mGy) were obtained from DICOM images and analysed. Clinical records of the patients were reviewed using the electronic patient record (EPR) system.
Result & Outcome :
54 female patients with 58 breast lesions were initially scheduled for DBT-guided breast biopsy during the period between 1/May/2018 and 31/Dec/2018. 6 patients were excluded from the study (2 patients had DBT-guided vacuum-assisted breast biopsy (VABB), and 4 patients did not proceed to biopsy on day of procedure after preliminary DBT). A final total of 48 female patients (Age:36-85yr; Mean: 54.6yr) with 52 lesions were included in the period. Technical success was achieved in 51 of 52 lesions (98%). One DBT biopsy procedure had to be switched to stereotactic-guided biopsy due to inability to visualize very faint microcalcifications. All target lesions were “high-contrast” lesions containing microcalcifications with lesion size ranging from 2-23mm (mean: 9.4mm). Histological results revealed benign changes in 88% (n=45) and malignant lesions in 12% (n=6) of the DBT-guided biopsied lesions. The mean total intervention time to complete DBT-guided needle biopsy was 11.49 minutes (11min 29s). Mean planning time was 4.80 minutes (4min 48s). Mean tissue sampling time was 6.67minutes (6min 40s). The mean number of imaging exposures acquired was 2.2 with an average glandular dose (AGD) to patients of 3.31mGy. No major complications were observed. In summary, results from our local institution have shown good clinical performance of DBT-guided needle biopsy with a very high technical success rate. Although there is no direct data comparison in this study, our local experience with DBT-guided biopsy is considerably faster to complete than the traditional stereotactic-guided biopsy method. A further advantage is that the procedure can also be done using fewer exposures to the patient. Use of DBT can improve lesion characterization. For example, in 4 of our patients that did not proceed with biopsy, their initial “microcalcifications” were further characterized as benign findings such as skin and vascular calcifications. This prevents patients from undergoing unnecessary procedures.

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