Does lateral arm technique decrease the rate of clip migration in stereotactic and tomosynthesis-guided biopsies?

Abstract

Background Mammography-guided vacuum-assisted biopsies (MGVAB) can be done with stereotaxis or digital breast tomosynthesis guidance. Both methods can be performed with a conventional (CBA) or a lateral arm biopsy approach (LABA). Marker clip migration is relatively frequent in MGVAB (up to 44%), which in cases requiring surgery carries a risk of positive margins and re-excision. We aimed to compare the rates of clip migration and hematoma formation between the CBA and LABA techniques of prone MGVAB. Our HIPAA compliant retrospective study included all consecutive prone MGVAB performed in a single institution over a 20-month period. The LABA approach was used with DBT guidance; CBA utilized DBT or stereotactic guidance. The tissue sampling techniques were otherwise identical. Results After exclusion, 389 biopsies on 356 patients were analyzed. LABA was done in 97 (25%), and CBA in 292 (75%) cases. There was no statistical difference in clip migration rate with either 1 cm or 2 cm distance cut-off [15% for CBA and 10% for LABA for 1 cm threshold (p = 0.31); 5.8% or CBA and 3.1% or LABA for 2 cm threshold (p = 0.43)]. There was no difference in the rate of hematoma formation (57.5% in CDB and 50.5% in LABA, p = 0.24). The rates of technical failure were similar for both techniques (1.7% for CBA and 3% for LABA) with a combined failure rate of 1%. Conclusions LABA and CBA had no statistical difference in clip migration or hematoma formation rates. Both techniques had similar success rates and may be helpful in different clinical situations.

Retrospective Comparison of the Lateral-Arm and Vertical Needle Approaches for Prone Tomosynthesis-Guided Breast Biopsy

“…Our findings compare similarly to prior studies that indicate LANA is safe and effective for normal and thinly compressed breast tissue. [2][3][4][5][6] We found no major complications, and the thinnest breast in our study compressed to 1.3 cm (compared with 2.9 cm for VNA). Weaver et al 5 observed no significant difference between LANA and VNA for bleeding or clip migration, again consistent with our findings.…”

“…[2][3][4][5][6] We found no major complications, and the thinnest breast in our study compressed to 1.3 cm (compared with 2.9 cm for VNA). Weaver et al 5 observed no significant difference between LANA and VNA for bleeding or clip migration, again consistent with our findings. Kerger et al 2 reported faster procedures and increased patient throughput with LANA, though we noted identical total procedure times for LANA and VNA (both 16 minutes, P = .96).…”

“…LANA or VNA was selected based on radiologist preference, which was most often determined by lesion type (calcification, distortion, asymmetry, or mass), lesion location, and breast compression thickness. Biopsy methods have been previously described 5 . All patients in that study who underwent biopsy with LANA overlapped with this study's population.…”

“…Advantages of LANA include high safety and efficacy, a fast learning curve, quicker procedure times, and the ability to sample lesions within breasts that compress as thinly as 1.0 cm. [2][3][4][5][6] The primary disadvantage is difficulty anesthetizing deep lesions. 3 Our study aimed to compare technical details and outcomes for LANA and VNA.…”

Unveiling Tissue Marker Migration in MRI-Guided Vacuum-Assisted Biopsies: Frequency, Factors, and Implications

“…Tissue marker placement after percutaneous breast biopsy is commonly used to enable accurate localization of lesions before surgery [1,2]. Several studies have shown that clip migration after stereotactic vacuum-assisted biopsy (SVAB), de ned as > 10mm displacement away from the biopsy cavity, is not rare [3][4][5][6][7][8][9][10]. Most cases of tissue marker displacement are believed to be caused by the "accordion effect", which is movement of the marker along the needle track immediately after the breast is decompressed [1,[11][12][13].…”