Tomosynthesis-Guided Needle Localization of Breast and Axillary Lesions: Our Initial Experience

Choudhery, Sadia; Simmons, Curtis; Harper, Laura; Lee, Christine

doi:10.2214/ajr.18.20363

Cited by 15 publications

(6 citation statements)

References 7 publications

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“…[3,7] Although DBT-guided percutaneous biopsies and needle localizations are increasingly utilized, this capability is not yet widely available. [17] Durand et al . highlighted the lack of evidence-based guidelines for management of DBT-detected AD with no correlate with other imaging modalities.…”

Section: Introductionmentioning

confidence: 99%

Positive Predictive Value of Tomosynthesis-guided Biopsies of Architectural Distortions Seen on Digital Breast Tomosynthesis and without an Ultrasound Correlate

Vijayaraghavan

Newburg

Vedantham

2019

JCIS

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Objective:The objective of the study was to determine the positive predictive value (PPV) of architectural distortions (AD) observed on digital breast tomosynthesis (DBT) and without an ultrasound (US) correlate.Materials and Methods:In this single-institution, retrospective study, patients who underwent DBT-guided biopsies of AD without any associated findings on digital mammography (DM) or DBT, and without a correlate on targeted US exam, over a 14-month period were included in this study. All patients had DM and DBT and targeted US exams. The PPV was computed along with the exact 95% confidence limits (CL) using simple binomial proportions, with histopathology as the reference standard.Results:A total of 45 ADs in 45 patients met the inclusion criteria. Histopathology indicated 6/45 (PPV: 13.3%, CL: 5.1–26.8%), ADs were malignant, including one high-risk lesion that was upgraded at surgery. ADs were appreciated only on DBT in 12/45 (26.7%) patients, and on both DBT and DM in 33/45 (73.3%) patients, and the corresponding PPV was 25% (3/12, CL: 5.5–57.2%) and 9.1% (3/33, CL: 1.9–24.3%), respectively. In all analyses, the observed PPV significantly exceeded the 2% probability of malignancy for Breast Imaging Reporting and Data System-3 diagnostic categories (P < 0.004).Conclusions:The PPV of malignancy in DBT detected AD without an US correlate in our series of 45 cases was 6/45 (13.3%). In the absence of an US correlate, the PPV of AD is lower than that mentioned in prior literature but exceeds the 2% threshold to justify DBT-guided biopsy.

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Section: Introductionmentioning

confidence: 99%

Positive Predictive Value of Tomosynthesis-guided Biopsies of Architectural Distortions Seen on Digital Breast Tomosynthesis and without an Ultrasound Correlate

Vijayaraghavan

Newburg

Vedantham

2019

JCIS

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“…When US is unsuccessful in identifying a marked axillary node, alternative imaging guidance such as CT or tomosynthesis can be considered. [8][9][10] A limited selection of biopsy markers with similar imaging characteristics was used for the cadaver model. ere are a variety of biopsy markers on the market, and a large number have been reviewed as options for localization of axillary lymph nodes.…”

Section: Figurementioning

confidence: 99%

Techniques for Improving Ultrasound Visualization of Biopsy Markers in Axillary Lymph Nodes

Lee¹,

Zhou

Hyde

et al. 2020

JCIS

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Objective: Biopsy markers are often placed into biopsy-proven metastatic axillary lymph nodes to ensure later accurate node excision. Ultrasound is the preferred imaging modality in the axilla. However, sonographic identification of biopsy markers after neoadjuvant therapy can be challenging. This is due to poor conspicuity relative to surrounding parenchymal interfaces, treatment-related alteration of malignant morphology during neoadjuvant chemotherapy, or extrusion of the marker from the target. To the authors’ knowledge, the literature provides no recommendations for ultrasound scanning parameters that improve the detection of biopsy markers. The purpose of this manuscript is 3-fold: (1) To determine scanning parameters that improve sonographic conspicuity of biopsy markers in a phantom and cadaver model; (2) to implement these scanning parameters in the clinical setting; and (3) to provide strategies that might increase the likelihood of successful ultrasound detection of biopsy markers in breast imaging practices. Materials and Methods: An ex vivo study was performed using a phantom designed to simulate the heterogeneity of normal mammary or axillary soft tissues. A selection of available biopsy markers was deployed into this phantom and ultrasound (GE LOGIQ E9) was performed. Scanning parameters were adjusted to optimize marker conspicuity. For the cadaver study, the biopsy markers were deployed using ultrasound guidance into axillary lymph nodes of a female cadaver. Adjustments in transducer frequency, dynamic range, cross-beam (spatial compound imaging), beam steering, speckle reduction imaging, harmonic imaging, colorization, and speed of sound were evaluated. Settings that improved marker detection were used clinically for a year. Results: Sonographic scanning settings that improved biopsy marker conspicuity included increasing transducer frequency, decreasing dynamic range, setting cross-beam to medium hybrid, turning on beam steering, and setting speckle reduction imaging in the mid-range. There was no appreciable improvement with harmonic imaging, colorization, or speed of sound. Conclusion: On a currently available clinical ultrasound scanning system, ultrasound scanning parameters can be adjusted to improve the conspicuity of biopsy markers. Overall, optimization requires a balance between techniques that clinically increase contrast (dynamic range, harmonic imaging, and steering) and those that minimize graininess (spatial compound imaging, speckle reduction imaging, and steering). Additional scanning and procedural strategies have been provided to improve the confidence of sonographic detection of biopsy markers closely associated with the intended target.

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“…Misplacement of the seed in the pectoralis muscle has also been reported previously in tomosynthesis-guided axillary localizations. 8 This can particularly happen with targets that are very deep in the axilla. Strategies such as placing the needle slightly deeper than the calculated depth 8 and success of alternative localization methods, such as CT-guided localizations, 10 have been previously described.…”

Section: Pitfallsmentioning

confidence: 99%

“…8 This can particularly happen with targets that are very deep in the axilla. Strategies such as placing the needle slightly deeper than the calculated depth 8 and success of alternative localization methods, such as CT-guided localizations, 10 have been previously described. Some targeted axillary nodes or clips may also be adjacent to large blood vessels, and it may be difficult to find a tomosynthesis-guided needle trajectory to avoid injury to those vessels.…”

Section: Pitfallsmentioning

confidence: 99%

“…Multiple prior studies have described the technique and feasibility of performing tomosynthesis-guided biopsies, 6,7 but there is overall limited literature on how to perform tomosynthesisguided localizations. 8 Tomosynthesis-guided localizations can be performed utilizing an alphanumeric grid on a standard digital breast tomosynthesis unit or by programming a tomosynthesis biopsy attachment, such as Affirm ® (Hologic, Bedford, MA), for localizations. In this review, we discuss our step-by-step approach for tomosynthesisguided seed localizations of the breast and axilla using a standard tomosynthesis unit and explore tips for success and pitfalls to avoid.…”

Section: Introductionmentioning

confidence: 99%

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Tomosynthesis-guided breast and axillary localizations: tips and tricks

Choudhery

Anderson

2020

The British Journal of Radiology

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As tomosynthesis is rapidly adopted by breast imaging practices, tomosynthesis-guided procedures are increasingly being performed. Tomosynthesis-guided needle localizations are feasible and efficient and allow for localization of tomosynthesis-only findings or one-view findings, which may be difficult to localize under standard digital mammography. In this review, we describe our step-by-step approach for performing tomosynthesis-guided localizations of the breast and axilla using a standard tomosynthesis unit.

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Tomosynthesis-Guided Needle Localization of Breast and Axillary Lesions: Our Initial Experience

Cited by 15 publications

References 7 publications

Positive Predictive Value of Tomosynthesis-guided Biopsies of Architectural Distortions Seen on Digital Breast Tomosynthesis and without an Ultrasound Correlate

Positive Predictive Value of Tomosynthesis-guided Biopsies of Architectural Distortions Seen on Digital Breast Tomosynthesis and without an Ultrasound Correlate

Techniques for Improving Ultrasound Visualization of Biopsy Markers in Axillary Lymph Nodes

Tomosynthesis-guided breast and axillary localizations: tips and tricks

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