Guiding vacuum-assisted biopsy in prone position: digital breast tomosynthesis vs stereotactic

Clinical benefits of tomosynthesis-guided vacuum assisted breast biopsy: a comparison with stereotactic vacuum assisted biopsy

BACKGROUND

Tomosynthesis-guided vacuum assisted breast biopsy (3D-VAB) has been used increasingly. The aim of our study is to compare the clinical effectiveness of 3D-VAB and stereotactic vacuum assisted biopsy (2D-VAB) on the number of tissue cores containing targeted calcifications and on the procedure time.

METHODS

Consecutive 87 women who underwent biopsy at our hospital from April 2020 to March 2022 for calcifications mammographically suspicious of malignancy were included in this study: 57 patients with 3D-VAB and 30 patients with 2D-VAB.

RESULTS

Grouped or clustered calcified lesions were found in 39 and 21 patients among the 3D-VAB group and the 2D-VAB group, respectively. The mean number of tissue cores per biopsy containing targeted calcifications from the grouped or clustered calcified lesions was 3 and 2.3 specimens for the 3D-VAB group and for the 2D-VAB group, respectively. The mean procedure time for grouped or clustered calcifications was significantly shorter in the 3D-VAB group than in the 2D-VAB group (16.5 min vs. 27.4 min, P < 0.01). Comparing the procedure time between 3D-VAB and 2D-VAB based on calcification category, 3D-VAB had significantly shorter procedure time than 2D-VAB for both category 3 and category 4 calcification. For all patients, the mean procedure time was 18.1 min for the 3D-VAB group and 27.7 min for the 2D-VAB, thus being significantly shorter with 3D-VAB than 2D-VAB (P < 0.01).

CONCLUSION

Our study demonstrated that the clinical effectiveness of 3D-VAB is superior to that of 2D-VAB and that the significant reduction in examination time with 3D-VAB is expected to benefit patients.

Practical Challenges of DBT-Guided VABB: Harms and Benefits, from Literature to Clinical Experience

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.

Utility of detection of breast calcifications with integrated real-time radiography system (IRRS) during digital breast tomosynthesis (DBT)-guided vacuum assisted biopsy (VAB): initial single-center experience

PURPOSE

To determine whether the presence of calcifications in specimens collected during stereotactic-guided vacuum-assisted breast biopsies (VABB) is sufficient to ascertain their adequacy for final diagnosis at pathology.

MATERIALS AND METHODS

Digital breast tomosynthesis (DBT)-guided VABBs were performed on 74 patients with calcifications as target. Each biopsy consisted of the collection of 12 samplings with a 9-gauge needle. This technique was integrated with a real-time radiography system (IRRS) which allowed the operator to determine whether calcifications were included in the specimens at the end of each of the 12 tissue collections through the acquisition of a radiograph of every sampling. Calcified and non-calcified specimens were separately sent to pathology and evaluated.

RESULTS

A total of 888 specimens were retrieved, 471 containing calcifications and 417 without. In 105 (22.2%) samples out of 471 with calcifications cancer was detected, while the remaining 366 (77.7%) were non-cancerous. Out of 417 specimens without calcifications 56 (13.4%) were cancerous, whereas 361 (86.5%) were non-cancerous. Seven hundred and twenty-seven specimens out of all 888 were cancer-free (81.8%, 95%CI 79-84%).

CONCLUSION

Although there is a statistical significative difference between calcified and non-calcified samples and the detection of cancer (p < 0.001), our study shows that the sole presence of calcifications in the specimens is not sufficient to determine their adequacy for final diagnosis at pathology because non-calcified samples can be cancerous and vice-versa. Ending biopsies when calcifications are first detected through IRRS could lead to false negative results.