Troubleshooting to Overcome Technical Challenges in Image-guided Breast Biopsy

Abstract

Image-guided breast biopsy with stereotactic, ultrasonographic, or magnetic resonance imaging guidance has become an integral component of every breast imaging program. It has many advantages over open surgical biopsy, including lower cost, lower patient morbidity, faster patient recovery, and minimal to no scarring, with equal accuracy to that of open surgical biopsy. Successful completion of a breast biopsy begins with thorough preprocedural planning to choose the appropriate imaging modality and most efficient biopsy approach. Patient mental and physical comorbidities, anticoagulation status, small or thin breasts, and breast implants, as well as lesion conspicuity and posterior, superficial, axillary, or subareolar location, pose technical challenges to successful image-guided breast biopsy that must be overcome. When biopsy is performed with use of a different imaging modality than that used to initially identify the target, careful preprocedural multimodality radiologic correlation, postprocedural identification of the biopsy marker location, and radiologic-pathologic correlation must be undertaken to ensure accurate biopsy of the intended target with use of the different modality. If, after employing all available strategic and procedural modifications, image-guided breast biopsy cannot be performed, then surgical excision of the intended target should be recommended at the time of biopsy cancellation to avoid a delay in diagnosis. This article reviews patient and lesion factors that pose technical challenges to successful breast biopsy and presents strategies and procedural modifications that aid in successful completion of breast biopsy in challenging situations. RSNA, 2017.

Ultrasound‐Guided Breast Biopsies

“…Hydrodissection is also used in other therapeutic breast interventions such as percutaneous ablations to protect the nipple/areolar complex 21 . This same technique can be translated into diagnostic breast procedures 22 …”

“…When targets are deep and lie directly on the pectoralis muscle, the usual strategy is to approach the biopsy from slightly farther away, allowing enough room to bring the device parallel to the chest wall 4,7,22 . Using hydrodissection, the mass may be displaced anteriorly by bolusing a local anesthetic or saline and creating a “safe zone” for biopsy.…”

Recent Progress for the Techniques of MRI-Guided Breast Interventions and their applications on Surgical Strategy

“…Besides, MRIguided intervention is a valid technique for the diagnosis of suspicious non-palpable lesions (NPLs) and small masses, which is easy to cause misdiagnosis and delay the treatment of the diseases. These MRIguided interventions, which are safe, accurate, and effective with a low complication rate that includes infection, hematoma information, and pneumothorax, have transformed the practice of breast imaging [10][11][12][13][14].…”

“…Albert Gubern-Mérida et al [43] propose a novel CAD system to detect breast lesions in dynamic contrast-enhanced MRI automatically. As for the manual localization method, landmarks including: vessels, biopsy clips, and other foci of background parenchymal enhancement can be used to help localize the target [12].…”

Comparação entre a tomossíntese e a ressonância magnética da mama para avaliar resposta tumoral após quimioterapia neoadjuvante: relato de caso

“…Cada vez mais, mastologistas e oncologistas escolhem a quimioterapia neoadjuvante, mesmo em casos de câncer não avançado, pois esta possibilita melhor resultado estético, melhor planejamento cirúrgico, redução da recidiva local e impacto na sobrevida global do paciente (CHESEBRO et. al., 2017).…”