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Rivera-Fernández JD, Hernández-Mendoza A, Fabila-Bustos DA, de la Rosa-Vázquez JM, Hernández-Chávez M, de la Rosa-Gutierrez G, Roa-Tort K. A Low-Cost Optomechatronic Diffuse Optical Mammography System for 3D Image Reconstruction: Proof of Concept. Diagnostics (Basel) 2025; 15:584. [PMID: 40075831 PMCID: PMC11898423 DOI: 10.3390/diagnostics15050584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2025] [Revised: 02/25/2025] [Accepted: 02/27/2025] [Indexed: 03/14/2025] Open
Abstract
Background: The development and initial testing of an optomechatronic system for the reconstruction of three-dimensional (3D) images to identify abnormalities in breast tissue and assist in the diagnosis of breast cancer is presented. Methods: This system combines 3D reconstruction technology with diffuse optical mammography (DOM) to offer a detecting tool that complements and assists medical diagnosis. DOM analyzes tissue properties with light, detecting density and composition variations. Integrating 3D reconstruction enables detailed visualization for precise tumor localization and sizing, offering more information than traditional methods. This technological combination enables more accurate, earlier diagnoses and helps plan effective treatments by understanding the patient's anatomy and tumor location. Results: Using Chinese ink, it was possible to identify simulated abnormalities of 10, 15, and 20 mm in diameter in breast tissue phantoms from cosmetic surgery. Conclusions: Data can be processed using algorithms to generate three-dimensional images, providing a non-invasive and safe approach for detecting anomalies. Currently, the system is in a pilot testing phase using breast tissue phantoms, enabling the evaluation of its accuracy and functionality before application in clinical studies.
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Affiliation(s)
- Josué D. Rivera-Fernández
- Laboratorio de Optomecatrónica y Energías, UPIIH, Instituto Politécnico Nacional, Distrito de Educación, Salud, Ciencia, Tecnología e Innovación, San Agustín Tlaxiaca 42162, Mexico; (A.H.-M.); (D.A.F.-B.); (M.H.-C.)
| | - Alfredo Hernández-Mendoza
- Laboratorio de Optomecatrónica y Energías, UPIIH, Instituto Politécnico Nacional, Distrito de Educación, Salud, Ciencia, Tecnología e Innovación, San Agustín Tlaxiaca 42162, Mexico; (A.H.-M.); (D.A.F.-B.); (M.H.-C.)
| | - Diego A. Fabila-Bustos
- Laboratorio de Optomecatrónica y Energías, UPIIH, Instituto Politécnico Nacional, Distrito de Educación, Salud, Ciencia, Tecnología e Innovación, San Agustín Tlaxiaca 42162, Mexico; (A.H.-M.); (D.A.F.-B.); (M.H.-C.)
| | - José M. de la Rosa-Vázquez
- Laboratorio de Biofotónica, ESIME-Zac, Instituto Politécnico Nacional, Gustavo A. Madero, Mexico City 07320, Mexico;
| | - Macaria Hernández-Chávez
- Laboratorio de Optomecatrónica y Energías, UPIIH, Instituto Politécnico Nacional, Distrito de Educación, Salud, Ciencia, Tecnología e Innovación, San Agustín Tlaxiaca 42162, Mexico; (A.H.-M.); (D.A.F.-B.); (M.H.-C.)
| | | | - Karen Roa-Tort
- Laboratorio de Optomecatrónica y Energías, UPIIH, Instituto Politécnico Nacional, Distrito de Educación, Salud, Ciencia, Tecnología e Innovación, San Agustín Tlaxiaca 42162, Mexico; (A.H.-M.); (D.A.F.-B.); (M.H.-C.)
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2
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Tran B, Mobley A, Colvin S, Woodard S. Classifying, recognizing, and troubleshooting errors in magnetic resonance imaging (MRI)-guided breast biopsies. Clin Radiol 2025; 81:106714. [PMID: 39462715 DOI: 10.1016/j.crad.2024.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 09/09/2024] [Accepted: 09/18/2024] [Indexed: 10/29/2024]
Abstract
MRI-guided biopsies can generate challenging scenarios. Errors can occur for many reasons, both preprocedural and intraprocedural. Radiology errors have been studied for many years, originally classified by Renfrew in 1992 and revised in 2014 by Kim and Mansfield. While classification systems have focused on diagnostic radiology; many can also apply to procedural errors. This review aims to use the Kim-Mansfield modification of the Renfrew error classification system to provide a discussion and review of common MRI-guided biopsy errors to help radiologists manage them efficiently and appropriately.
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Affiliation(s)
- B Tran
- The University of Alabama at Birmingham Marnix E. Heersink School of Medicine. 1670 University Blvd, Birmingham, AL 35233, USA.
| | - A Mobley
- The University of Alabama at Birmingham Marnix E. Heersink School of Medicine. 1670 University Blvd, Birmingham, AL 35233, USA.
| | - S Colvin
- Department of Radiology. The University of Alabama at Birmingham. 1802 6th Avenue South, Birmingham, AL 35233, USA.
| | - S Woodard
- Department of Radiology. The University of Alabama at Birmingham. 1802 6th Avenue South, Birmingham, AL 35233, USA.
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3
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Dodelzon K, Grimm L, Coffey K, Reig B, Mullen L, Dashevsky BZ, Bhole S, Parikh JR. Tips and Tricks for Image-Guided Breast Biopsies: Technical Factors for Success. JOURNAL OF BREAST IMAGING 2024; 6:658-667. [PMID: 39313444 PMCID: PMC11875097 DOI: 10.1093/jbi/wbae055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Indexed: 09/25/2024]
Abstract
Image-guided biopsy is an integral step in the diagnosis and management of suspicious image-detected breast or axillary lesions, allowing for accurate diagnosis and, if indicated, treatment planning. Tissue sampling can be performed under guidance of a full spectrum of breast imaging modalities, including stereotactic, tomosynthesis, sonographic, and MRI, each with its own set of advantages and limitations. Procedural planning, which includes consideration of technical, patient, and lesion factors, is vital for diagnostic accuracy and limitation of complications. The purpose of this paper is to review and provide guidance for breast imaging radiologists in selecting the best procedural approach for the individual patient to ensure accurate diagnosis and optimal patient outcomes. Common patient and lesion factors that may affect successful sampling and contribute to postbiopsy complications are reviewed and include obesity, limited patient mobility, patient motion, patients prone to vasovagal reactions, history of anticoagulation, and lesion location, such as proximity to vital structures or breast implant.
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Affiliation(s)
- Katerina Dodelzon
- Weill Cornell Medicine at NewYork-Presbyterian, Department of Radiology, New York, New York, USA
| | - Lars Grimm
- Duke University Medical Center, Department of Radiology, Durham, North Carolina, USA
| | - Kristen Coffey
- Weill Cornell Medicine at NewYork-Presbyterian, Department of Radiology, New York, New York, USA
| | - Beatriu Reig
- New York University Grossman School of Medicine, Department of Radiology New York, NY, USA
| | - Lisa Mullen
- Johns Hopkins Medicine, Department of Radiology, Baltimore, MD, USA
| | - Brittany Z Dashevsky
- Stanford University School of Medicine, Department of Radiology, Stanford, CA, USA
| | - Sonya Bhole
- Northwestern University, Feinberg School of Medicine, Department of Radiology Chicago IL, USA
| | - Jay R. Parikh
- The University of Texas MD Anderson Cancer Center, Department of Radiology Houston, TX USA
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4
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Tari DU, De Lucia DR, Santarsiere M, Santonastaso R, Pinto F. Practical Challenges of DBT-Guided VABB: Harms and Benefits, from Literature to Clinical Experience. Cancers (Basel) 2023; 15:5720. [PMID: 38136264 PMCID: PMC10742222 DOI: 10.3390/cancers15245720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 11/25/2023] [Accepted: 12/04/2023] [Indexed: 12/24/2023] Open
Abstract
Vacuum-assisted breast biopsy (VABB) guided by digital breast tomosynthesis (DBT) represents one of the best instruments to obtain a histological diagnosis of suspicious lesions with no ultrasound correlation or those which are visible only on DBT. After a review of the literature, we retrospectively analyzed the DBT-guided VABBs performed from 2019 to 2022 at our department. Descriptive statistics, Pearson's correlation and χ2 test were used to compare distributions of age, breast density (BD) and early performance measures including histopathology. We used kappa statistics to evaluate the agreement between histological assessment and diagnosis. Finally, we compared our experience to the literature to provide indications for clinical practice. We included 85 women aged 41-84 years old. We identified 37 breast cancers (BC), 26 stage 0 and 11 stage IA. 67.5% of BC was diagnosed in women with high BD. The agreement between VABB and surgery was 0.92 (k value, 95% CI: 0.76-1.08). We found a statistically significant inverse correlation between age and BD. The post-procedural clip was correctly positioned in 88.2%. The post-procedural hematoma rate was 14.1%. No infection or hemorrhage were recorded. When executed correctly, DBT-guided VABB represents a safe and minimally invasive technique with high histopathological concordance, for detecting nonpalpable lesions without ultrasound correlation.
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Affiliation(s)
- Daniele Ugo Tari
- Department of Breast Imaging, Caserta Local Health Authority, District 12 “Palazzo della Salute”, 81100 Caserta, Italy; (D.R.D.L.); (M.S.)
| | - Davide Raffaele De Lucia
- Department of Breast Imaging, Caserta Local Health Authority, District 12 “Palazzo della Salute”, 81100 Caserta, Italy; (D.R.D.L.); (M.S.)
| | - Marika Santarsiere
- Department of Breast Imaging, Caserta Local Health Authority, District 12 “Palazzo della Salute”, 81100 Caserta, Italy; (D.R.D.L.); (M.S.)
| | | | - Fabio Pinto
- Department of Radiology, “A. Guerriero” Hospital, Caserta Local Health Authority, 81025 Marcianise, Italy;
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5
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Yeow YJ, Yu CC, Cheung YC, Chen SC. A cohort study of mammography-guided vacuum-assisted breast biopsy in patients with compressed thin breasts (≦ 3 cm). Asian J Surg 2023; 46:4296-4301. [PMID: 37150735 DOI: 10.1016/j.asjsur.2023.04.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/28/2023] [Accepted: 04/18/2023] [Indexed: 05/09/2023] Open
Abstract
OBJECTIVES In the women with compressed thin thickness (≦ 3 cm), mammographic guiding vacuum-assist breast biopsy (MG-VABB) is a technical challenge. We herein report their performance of MG-VABB on suspicious microcalcification by modern mammography. METHODS We retrospectively reviewed the consecutive MG-VABB in our hospital from February 2019 to January 2021. All the patients received biopsy because of suspicious microcalcifications discovered by mammography and had at least one-year post-biopsy follow-up. RESULTS We reviewed 745 consecutive patients revealing 195 with compressed thin breasts ≦ 3 cm (mean age: 50.12 ± 7.0; breast thickness: 24.99 mm range 11.6-30 mm). Of the 191 patients received biopsy, the microcalcification retrieval rate was 97.9%. Using the half-open notch biopsy or horizontal needle approach, the biopsies were technically achieved in 30.4% and 9.4% of patients respectively. Regarding to the gold standard of surgicohistology, the cancer sensitivities was 88.46% and the atypia upgrade rate was 16.67%. There was no statistical difference of the procedure time between stereotactic guided and tomosynthesis guided. CONCLUSIONS The modern MG-VABB has technically improve the performance of biopsy to the patients with compressed thin breasts (≦ 3 cm), revealing approximate results to those breasts > 3 cm. The diagnosis helps the management of suspicious microcalcifications discovered by mammography.
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Affiliation(s)
- Yun-Jen Yeow
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, 5 Fuxing St., Guishan, Taoyuan, Taiwan
| | - Chi-Chang Yu
- Medial college of Chang Gung University, 5 Fuxing Sr., Guishan, Taoyuan, Taiwan; Department of General Surgery, Chang Gung Memorial Hospital, Taiwan
| | - Yun-Chung Cheung
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, 5 Fuxing St., Guishan, Taoyuan, Taiwan; Medial college of Chang Gung University, 5 Fuxing Sr., Guishan, Taoyuan, Taiwan.
| | - Shin-Cheh Chen
- Medial college of Chang Gung University, 5 Fuxing Sr., Guishan, Taoyuan, Taiwan; Department of General Surgery, Chang Gung Memorial Hospital, Taiwan
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Vogel-Minea CM, Bader W, Blohmer JU, Duda V, Eichler C, Fallenberg EM, Farrokh A, Golatta M, Gruber I, Hackelöer BJ, Heil J, Madjar H, Marzotko E, Merz E, Müller-Schimpfle M, Mundinger A, Ohlinger R, Peisker U, Schäfer FK, Schulz-Wendtland R, Solbach C, Warm M, Watermann D, Wojcinski S, Dudwiesus H, Hahn M. Best Practice Guideline - DEGUM Recommendations on Breast Ultrasound. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2023; 44:520-536. [PMID: 37072031 DOI: 10.1055/a-2020-9904] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Alongside mammography, breast ultrasound is an important and well-established method in assessment of breast lesions. With the "Best Practice Guideline", the DEGUM Breast Ultrasound (in German, "Mammasonografie") working group, intends to describe the additional and optional application modalities for the diagnostic confirmation of breast findings and to express DEGUM recommendations in this Part II, in addition to the current dignity criteria and assessment categories published in Part I, in order to facilitate the differential diagnosis of ambiguous lesions.The present "Best Practice Guideline" has set itself the goal of meeting the requirements for quality assurance and ensuring quality-controlled performance of breast ultrasound. The most important aspects of quality assurance are explained in this Part II of the Best Practice Guideline.
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Affiliation(s)
- Claudia Maria Vogel-Minea
- Brustzentrum, Diagnostische und Interventionelle Senologie, Rottal-Inn Kliniken Eggenfelden, Eggenfelden, Germany
| | - Werner Bader
- Zentrum für Frauenheilkunde, Brustzentrum, Universitätsklinikum OWL der Universität Bielefeld, Campus Klinikum Bielefeld, Bielefeld, Germany
| | - Jens-Uwe Blohmer
- Klinik für Gynäkologie mit Brustzentrum, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Volker Duda
- Senologische Diagnostik, Universitätsklinikum Gießen und Marburg, Marburg, Germany
| | - Christian Eichler
- Klinik für Brusterkrankungen, St Franziskus-Hospital Münster GmbH, Münster, Germany
| | - Eva Maria Fallenberg
- Department of Diagnostic and Interventional Radiology, Technical University of Munich Hospital Rechts der Isar, Munich, Germany
| | - André Farrokh
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Michael Golatta
- Sektion Senologie, Universitäts-Frauenklinik Heidelberg, Heidelberg, Germany
- Brustzentrum Heidelberg, Klinik St. Elisabeth, Heidelberg, Germany
| | - Ines Gruber
- Frauenklinik, Department für Frauengesundheit, Universitätsklinikum Tübingen, Tübingen, Germany
| | | | - Jörg Heil
- Sektion Senologie, Universitäts-Frauenklinik Heidelberg, Heidelberg, Germany
- Brustzentrum Heidelberg, Klinik St. Elisabeth, Heidelberg, Germany
| | - Helmut Madjar
- Gynäkologie und Senologie, Praxis für Gynäkologie, Wiesbaden, Germany
| | - Ellen Marzotko
- Mammadiagnostik, Frauenheilkunde und Geburtshilfe, Praxis, Erfurt, Germany
| | - Eberhard Merz
- Frauenheilkunde, Zentrum für Ultraschall und Pränatalmedizin, Frankfurt, Germany
| | - Markus Müller-Schimpfle
- DKG-Brustzentrum, Klinik für Radiologie, Neuroradiologie und Nuklearmedizin, varisano Klinikum Frankfurt Höchst, Frankfurt am Main, Germany
| | - Alexander Mundinger
- Brustzentrum Osnabrück - Bildgebende und interventionelle Mamma Diagnostik, Franziskus Hospital Harderberg, Niels Stensen Kliniken, Georgsmarienhütte, Germany
| | - Ralf Ohlinger
- Interdisziplinäres Brustzentrum, Universitätsmedizin Greifswald, Klinik für Frauenheilkunde und Geburtshilfe, Greifswald, Germany
| | - Uwe Peisker
- BrustCentrum Aachen-Kreis Heinsberg, Hermann-Josef Krankenhaus, Akademisches Lehrkrankenhaus der RWTH-Aachen, Erkelenz, Germany
| | - Fritz Kw Schäfer
- Bereich Mammadiagnostik und Interventionen, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | | | - Christine Solbach
- Senologie, Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Mathias Warm
- Brustzentrum, Krankenhaus Holweide, Kliniken der Stadt Köln, Koeln, Germany
| | - Dirk Watermann
- Frauenklinik, Evangelisches Diakoniekrankenhaus, Freiburg, Germany
| | - Sebastian Wojcinski
- Zentrum für Frauenheilkunde, Brustzentrum, Universitätsklinikum OWL Bielefeld, Bielefeld, Germany
| | | | - Markus Hahn
- Frauenklinik, Department für Frauengesundheit, Universität Tübingen, Tübingen, Germany
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Choi WJ, Kim HH. Mammography-Guided Interventional Procedure. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:320-331. [PMID: 37051394 PMCID: PMC10083631 DOI: 10.3348/jksr.2022.0145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/12/2023] [Accepted: 02/08/2023] [Indexed: 03/09/2023]
Abstract
Mammography has been the standard screening method for breast cancer. In women with suspicious calcifications and architectural distortion identified on mammography or digital breast tomosynthesis only without detected on breast US, stereotactic biopsy and mammography-guided preoperative localization is one of the method for pathologic diagnosis. This review aims to describe the indication, contraindication, technique of stereotactic biopsy, clip placement after stereotactic biopsy, and digital breast tomosynthesis-guided stereotactic biopsy. In addition, this article reviews mammography-guided preoperative localization using a wire or non-wire device.
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Affiliation(s)
- Woo Jung Choi
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hak Hee Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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8
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Niketa C, Pang KA, Lim JW. Challenges in MRI-Guided Breast Biopsy and Some Suggested Strategies: Case Based Review. Diagnostics (Basel) 2022; 12:1985. [PMID: 36010334 PMCID: PMC9407085 DOI: 10.3390/diagnostics12081985] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/04/2022] [Accepted: 08/06/2022] [Indexed: 11/16/2022] Open
Abstract
With the increasing use of MRI in clinical practice, the need for MRI-guided intervention is also increasing. Indeterminate lesions identified on MRI without mammographic or sonographic correlates will need to be approached under MRI guidance. MRI-guided biopsy is a skill that can be acquired with proper training and guidance. These procedures have their own set of challenges and issues; some of them are specific to the patient habitus in this region. Adequate knowledge and understanding of the challenges can help the radiologist to be better equipped to face these issues and solve them promptly during the procedure, thus increasing the overall success rate of the procedure. Not much local data from Asian countries is available on this front. This paper aims to share common challenges one may face while performing MRI-guided biopsy and share some tips and tricks to address these problems. Hopefully, this will help the readers achieve a higher success rate for MRI-guided interventions in their clinical practice.
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Affiliation(s)
- Chotai Niketa
- Radlink Diagnostic Imaging Center, #08-08, 290 Orchard Road, Singapore 238851, Singapore
| | - Kathleen Ann Pang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Joon Wei Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
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9
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James J. Contrast-enhanced spectral mammography (CESM)-guided breast biopsy as an alternative to MRI-guided biopsy. Br J Radiol 2022; 95:20211287. [PMID: 35015574 PMCID: PMC9153694 DOI: 10.1259/bjr.20211287] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective: Contrast-enhanced spectral mammography (CESM) breast biopsy has been recently introduced into clinical practice. This short communication describes the technique and potential as an alternative to MRI-guided biopsy. Methods and materials: An additional abnormality was detected on a breast MRI examination in a patient with lobular carcinoma. The lesion was occult on conventional mammography, tomosynthesis and ultrasound and required histological diagnosis. Traditionally, this would have necessitated an MRI-guided breast biopsy, but was performed under CESM guidance. Results: A diagnostic CESM study was performed to ensure the lesion visibility with CESM and then targeted under CESM guidance. A limited diagnostic study, CESM scout and paired images for stereotactic targeting were obtained within a 10 min window following a single injection of iodinated contrast agent. The time from positioning in the biopsy device to releasing compression after biopsy and marker clip placement was 15 min. The biopsy confirmed the presence of multifocal breast cancer. Conclusion: CESM-guided breast biopsy is a new technique that can be successfully used as an alternative to MRI-guided breast biopsy. Advances in knowledge: CESM-guided biopsy can be used to sample breast lesions which remain occult on standard mammography and ultrasound.
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Affiliation(s)
- Jonathan James
- Nottingham Breast Institute, Nottingham University Hospitals, Nottingham, UK
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10
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Shahan CL, Layne GP. Advances in Breast Imaging with Current Screening Recommendations and Controversies. Obstet Gynecol Clin North Am 2022; 49:1-33. [DOI: 10.1016/j.ogc.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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11
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The Challenging Image-Guided Preoperative Breast Localization: A Modality-Based Approach. AJR Am J Roentgenol 2021; 218:423-434. [PMID: 34612680 DOI: 10.2214/ajr.21.26664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Breast conservation surgery (BCS) is the standard of care for treating patients with early-stage breast cancer and those with locally advanced breast cancer who achieve an excellent response to neoadjuvant chemotherapy. The radiologist is responsible for accurately localizing nonpalpable lesions to facilitate successful BCS. In this article, we present a practical modality-based guide on approaching challenging preoperative localizations, incorporating illustrative examples of challenging localizations performed under sonographic, mammographic, and MRI guidance, as well as under multiple modalities. Aspects of preprocedure planning, modality selection, patient communication, as well as procedural and positional techniques are highlighted. Clip and device migration is also considered. Further, an overview is provided of the most widely used wire localization (WL) and non-wire localization (NWL) devices in the United States. Accurate preoperative localization of breast lesions is essential to achieve successful surgical outcomes. Certain modality-based techniques can be adopted to successfully complete challenging cases.
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12
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Vijapura CA, Wahab RA, Thakore AG, Mahoney MC. Upright Tomosynthesis-guided Breast Biopsy: Tips, Tricks, and Troubleshooting. Radiographics 2021; 41:1265-1282. [PMID: 34357806 DOI: 10.1148/rg.2021210017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The advent and implementation of digital breast tomosynthesis (DBT) have had a significant effect on breast cancer detection and image-guided breast procedures. DBT has been shown to improve the visualization of architectural distortions and noncalcified masses. With the incorporation of DBT imaging, biopsy of those findings seen only with DBT is feasible, and the need for localization and surgical excision to determine the pathologic diagnosis is avoided. The additional benefits of reduced procedural time, better localization, and increased technical success support the use of DBT for breast biopsy. DBT-guided biopsy can be performed with the patient prone or upright, depending on the table or unit used. Upright positioning enables improved patient comfort, particularly in patients who have restricted mobility, weight-related limitations, and/or difficulty lying prone for an extended period. Upright DBT-guided breast procedures require a cohesive team approach with overlapping radiologist and technologist responsibilities. Since this is a common breast procedure, the radiologist should be familiar with preprocedural considerations, patient preparations, and use of the biopsy equipment. The basic principles of upright DBT-guided breast biopsy are described in this comprehensive review. The various procedural components, including alternative approaches and techniques, are discussed. Tips and tricks for navigating the biopsy procedure to minimize complications, imaging examples of crucial steps, and supporting diagrams are provided. In addition, the challenges of performing upright DBT-guided biopsy, with troubleshooting techniques to ensure a successful procedure, are reviewed. ©RSNA, 2021.
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Affiliation(s)
- Charmi A Vijapura
- From the Department of Radiology, University of Cincinnati Medical Center, 234 Goodman St, Cincinnati, OH 45219-0772
| | - Rifat A Wahab
- From the Department of Radiology, University of Cincinnati Medical Center, 234 Goodman St, Cincinnati, OH 45219-0772
| | - Atharva G Thakore
- From the Department of Radiology, University of Cincinnati Medical Center, 234 Goodman St, Cincinnati, OH 45219-0772
| | - Mary C Mahoney
- From the Department of Radiology, University of Cincinnati Medical Center, 234 Goodman St, Cincinnati, OH 45219-0772
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13
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Bhatt AA, Whaley DH, Lee CU. Ultrasound-Guided Breast Biopsies: Basic and New Techniques. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:1427-1443. [PMID: 32997819 PMCID: PMC8246574 DOI: 10.1002/jum.15517] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/18/2020] [Accepted: 09/11/2020] [Indexed: 05/28/2023]
Abstract
Ultrasound-guided breast biopsies can be challenging to perform, especially when the target is adjacent to the nipple, skin, or implant or when the target is small and in very posterior, dense fibroglandular tissue. Oftentimes, a slightly modified approach can result in a diagnostic biopsy specimen with minimal complications. After a brief review of basic techniques for ultrasound-guided breast biopsies that includes a review of conventional breast biopsy devices, a presentation of procedural modifications and techniques to consider for more challenging cases is described. In particular, novel open-trough and tandem-needle techniques are detailed. Several cases using these techniques are then presented.
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Affiliation(s)
- Asha A. Bhatt
- Department of RadiologyMayo ClinicRochesterMinnesotaUSA
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Lack of definitive presurgical pathological diagnosis is associated with inadequate surgical margins in breast-conserving surgery. Eur J Surg Oncol 2021; 47:2483-2491. [PMID: 34120811 DOI: 10.1016/j.ejso.2021.05.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/30/2021] [Accepted: 05/30/2021] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To determine the impact of definitive presurgical diagnosis on surgical margins in breast-conserving surgery (BCS) for primary carcinomas; clinicopathological features were also analyzed. METHODS This retrospective study included women who underwent BCS for primary carcinomas in 2016 and 2017. Definitive presurgical diagnosis was defined as having a presurgical core needle biopsy (CNB) and not being upstaged between biopsy and surgery. Biopsy data and imaging findings including breast density were retrieved. Inadequate surgical margins (IM) were defined per latest ASCO and ASTRO guidelines. Univariable and multivariable analyses were performed. RESULTS 360 women (median age, 66) met inclusion criteria with 1 having 2 cancers. 82.5% (298/361) were invasive cancers while 17.5% (63/361) were ductal carcinoma in situ (DCIS). Most biopsies were US-guided (284/346, 82.0%), followed by mammographic (60/346, 17.3%), and MRI-guided (2/346, 0.6%). US and mammographic CNB yielded median samples of 2 and 4, respectively, with a 14G needle. 15 patients (4.2%) lacked presurgical CNB. The IM rate was 30.0%. In multivariable analysis, large invasive cancers (>20 mm), dense breasts, and DCIS were associated with IM (p = 0.029, p = 0.010, and p = 0.013, respectively). Most importantly, lack of definitive presurgical diagnosis was a risk factor for IM (OR, 2.35; 95% CI: 1.23-4.51, p = 0.010). In contrast, neither patient age (<50) nor aggressive features (e.g., LVI) were associated with IM. CONCLUSION Lack of a definitive presurgical diagnosis was associated with a two-fold increase of IM in BCS; other risk factors were dense breasts, large invasive cancers, and DCIS.
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Meta-analysis and cost-effectiveness of ductoscopy, duct excision surgery and MRI for the diagnosis and treatment of patients with pathological nipple discharge. Breast Cancer Res Treat 2021; 186:285-293. [PMID: 33475877 PMCID: PMC7990840 DOI: 10.1007/s10549-021-06094-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 01/04/2021] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Pathological nipple discharge (PND) is a common breast-related complaint for referral to a surgical breast clinic because of its association with breast cancer. The aim of this meta-analysis was to compare the diagnostic efficacy of magnetic resonance imaging (MRI) and ductoscopy in patients with PND. Additionally, we determined the most cost-efficient strategy for the treatment of PND and the detection of breast cancer in PND patient without radiological suspicion for malignancy. MATERIALS AND METHODS PubMed and EMBASE were searched to collect the relevant literature from the inception of both diagnostic methods until January 27th 2020. The search yielded 815 original citations, of which 10 studies with 894 patients were finally included for analysis. Costs of ductoscopy, MRI and duct excision surgery were obtained from the UMC Utrecht as established in the year 2019. These costs included: medical personnel, overhead costs, material costs and sterilisation costs. RESULTS The meta-analysis showed no significant difference in sensitivity between ductoscopy (44%) and MRI (76%) for the detection of malignancy in patients with PND. However, ductoscopy (98%) had a statistically significantly higher specificity than MRI (84%). Individual costs were €1401.33, €822.13 and €6494.27 for ductoscopy, MRI and duct excision surgery, respectively. Full diagnostic strategy involving ductoscopy was on average €1670.97, while with MRI it was €2070.27. CONCLUSION Patients undergoing MRI are more often (false) positive which more often leads to duct excision surgery referrals compared to ductoscopy. This makes ductoscopy significantly more cost-effective compared MRI in patients with PND without radiological suspicion for malignancy.
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Abstract
OBJECTIVE. The objective of our study was to compare the performance of digital breast tomosynthesis (DBT)-guided prone and upright breast biopsies. MATERIALS AND METHODS. In this retrospective study, we reviewed all consecutive DBT-guided breast biopsies performed at our institution from May 1, 2018, to July 31, 2019. We recorded patient age, breast density, biopsy indications and technique, number of samples obtained, number of exposures performed, procedure times, percentage of calcifications removed, biopsy complications, histopathologic diagnosis, and radiology-pathology concordance. These characteristics were then compared between biopsy methods using the chi-square test or Wilcoxon rank sum test. RESULTS. There were 282 patients in our study: 215 patients (76.2%) underwent prone DBT-guided biopsy, and 67 (23.8%) underwent upright DBT-guided biopsy. All patients (100%) had technically successfully biopsies. The mean number of exposures for upright biopsies was significantly lower than the mean number of exposures for prone biopsies (p < 0.001). Otherwise, there was no significant difference between the two biopsy methods in the mean number of samples acquired (p = 0.26), mean procedure time (p = 0.67), percentage of calcifications removed (p = 0.31), or biopsy complications (p = 0.56). CONCLUSION. Besides the mean number of exposures acquired, prone and upright DBT-guided biopsies have similar clinical performance. Other factors, such as room utilization and patient comfort, should be considered when deciding between prone and upright DBT-guided biopsies.
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Gao P, Kong X, Song Y, Song Y, Fang Y, Ouyang H, Wang J. Recent Progress for the Techniques of MRI-Guided Breast Interventions and their applications on Surgical Strategy. J Cancer 2020; 11:4671-4682. [PMID: 32626513 PMCID: PMC7330700 DOI: 10.7150/jca.46329] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 05/09/2020] [Indexed: 01/20/2023] Open
Abstract
With a high sensitivity of breast lesions, MRI can detect suspicious lesions which are occult in traditional breast examination equipment. However, the lower and variable specificity of MRI makes the MRI-guided intervention, including biopsies and localizations, necessary before surgery, especially for patients who need the treatment of breast-conserving surgery (BCS). MRI techniques and patient preparation should be first carefully considered before the intervention to avoid lengthening the procedure time and compromising targeting accuracy. Doctors and radiologists need to reconfirm the target of the lesion and be very familiar with the process approach and equipment techniques involving the computer-aided diagnosis (CAD) tools and the biopsy system and follow a correct way. The basic steps of MRI-guided biopsy and localization are nearly the same regardless of the vendor or platform, and this article systematically introduces detailed methods and techniques of MRI-guided intervention. The two interventions both face different challenging situations during procedures with solutions given in the article. Post-operative statistics show that the complications of MRI-guided intervention are infrequent and mild, and MRI-guided biopsy provides the pathological information for the subsequent surgical decisions and MRI-guided localization fully prepared for follow-up surgical biopsy. New techniques for MRI-guided intervention are also elaborated in the article, which leads to future development. In a word, MRI-guided intervention is a safe, accurate, and effective technique with a low complication rate and successful MRI-guided intervention is truly teamwork with efforts from patients to surgeons, radiologists, MRI technologists, and nurses.
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Affiliation(s)
- Peng Gao
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Xiangyi Kong
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Ying Song
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yan Song
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yi Fang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Han Ouyang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jing Wang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
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Chikarmane S, Jin B, Giess C. Accuracy of MRI-directed ultrasound and subsequent ultrasound-guided biopsy for suspicious breast MRI findings. Clin Radiol 2020; 75:185-193. [DOI: 10.1016/j.crad.2019.10.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 10/21/2019] [Indexed: 11/26/2022]
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Biopsy needle integrated with multi-modal physical/chemical sensor array. Biosens Bioelectron 2020; 148:111822. [DOI: 10.1016/j.bios.2019.111822] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/16/2019] [Accepted: 10/23/2019] [Indexed: 12/19/2022]
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Abstract
OBJECTIVE. The purpose of this article is to review the literature regarding image-guided breast procedures, including helpful tips and tricks to guide the practicing interventional breast radiologist. CONCLUSION. The successful diagnosis and treatment of breast cancer involves coordination of the multidisciplinary breast team. Optimal procedural skills for image-guided biopsy and preoperative lesion localization are paramount to the radiologists' success.
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Biopsies mammaires sous tomosynthèse. IMAGERIE DE LA FEMME 2018. [DOI: 10.1016/j.femme.2018.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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