CURRENT METHODS IN IMAGE GUIDED BREAST BIOPSY

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1 CURRENT METHODS IN IMAGE GUIDED BREAST BIOPSY Stuart Silver April 24, 2004 OBJECTIVES Review development of current techniques Discuss stereotactic breast biopsy Discuss US guided breast biopsy 1

2 OBJECTIVES Introduce MRI guided biopsy Introduce vacuum-assisted assisted biopsy devices ALONG THE WAY Emphasize the importance of concordance between biopsy results and expected diagnosis Review breast biopsy results at Victoria General Hospital breast centre Discuss the role of the radiologist in directing and managing image guided biopsies 2

3 ALONG THE WAY Emphasize the importance of concordance between biopsy results and expected diagnosis Review breast biopsy results at Victoria General Hospital breast centre Discuss the role of the radiologist in directing and managing image guided biopsies ALONG THE WAY Emphasize the importance of concordance between biopsy results and expected diagnosis Review breast biopsy results at Victoria General Hospital breast centre Discuss the role of the radiologist in directing and managing image guided biopsies 3

4 IMAGE GUIDED BREAST BIOPSY Developed as alternative to fine wire guided excision biopsy IMAGE GUIDED BREAST BIOPSY Traditional wire guided excision biopsy cancer rates 20-30% 4

5 IMAGE GUIDED BREAST BIOPSY Accurate and reliable Decreased patient morbidity Cost effective Used for abnormal imaging findings, not palpable abnormalities IMAGE GUIDED BREAST BIOPSY Fine needle aspirate cytology Core biopsy - histology 5

IMAGE GUIDED BREAST BIOPSY Not every lesion that

Computer determines depth from 2 images obtained at

6 IMAGE GUIDED BREAST BIOPSY Not every lesion that can be biopsied, should be biopsied Radiologist determines which lesion needs biopsy, and appropriate method STEREOTACTIC BREAST BIOPSY Computer determines depth from 2 images obtained at different angulations Now used almost exclusively for microcalcifications 6

BIOPSY Advantages: cost, space, efficiency

7 STEREOTACTIC BREAST BIOPSY Stereotactic add on to standard mammography machine STEREOTACTIC BREAST BIOPSY Advantages: cost, space, efficiency Disadvantages: access to some calcifications limited, vasovagal episodes 7

BREAST BIOPSY Accuracy depends on showing representative micros on specimen X-rayX

8 STEREOTACTIC BREAST BIOPSY Prone stereotactic table Advantages: improved access to micros in all locations, patient comfort Disadvantages: cost, space, efficiency STEREOTACTIC BREAST BIOPSY Accuracy depends on showing representative micros on specimen X-rayX Histology must be correlated with imaging If biopsy results do not match expectation, follow up! 8

US GUIDED BREAST BIOPSY US initially limited to

BIOPSY Advantages: improved resolution allows

9 US GUIDED BREAST BIOPSY US initially limited to cyst vs. solid Improved resolution has increased sensitivity and specificity US GUIDED BREAST BIOPSY Advantages: improved resolution allows accurate biopsy of lesions to 3mm Fast, comfortable, real-time confirmation of needle position 9

10 US GUIDED BREAST BIOPSY Accuracy determined by operator Histology must be correlated with imaging. If biopsy results do not match expectation, follow up! US GUIDED BREAST BIOPSY Most commonly performed image guided breast biopsy Accurate and reliable when performed by experienced operator 10

11 BREAST BIOPSY STATISTICS: VICTORIA GENERAL HOSPITAL (480) 2002 (485) 2003 (538) Stereo Biopsy US Biopsy BREAST BIOPSY STATISTICS: VGH Benign Cancer 50 0 Stereo Biopsy (35%) US Biopsy (54%) 11

8% Non concordant biopsies: Stereo 19/85 22% US 56/453 12% MRI GUIDED

12 BREAST BIOPSY STATISTICS: VGH 2003 Non-diagnostic biopsies: Stereo 1/85 1% US 4/ % Non concordant biopsies: Stereo 19/85 22% US 56/453 12% MRI GUIDED BREAST BIOPSY Expanding role of MRI in breast imaging Increased sensitivity, decreased specificity Most lesions can be localized with US 12

13 MRI GUIDED BREAST BIOPSY Indications : search for occult primary, screen in high risk dense breasts, assess for multifocal disease. Need to be able to biopsy MRI detected lesion MRI GUIDED BREAST BIOPSY 13

MRI GUIDED BREAST BIOPSY Advantages: allows biopsy of lesion only seen at

confirm accurate biopsy, difficult to correlate histology with imaging.

Post-contrast VACUUM-ASSISTED ASSISTED BREAST BIOPSY Developed to increase

14 MRI GUIDED BREAST BIOPSY Advantages: allows biopsy of lesion only seen at MRI Disadvantages: cost, time, patient comfort, accuracy Difficult to confirm accurate biopsy, difficult to correlate histology with imaging. Left Breast Right Breast Pre-contrast Immediately Post-contrast 5 Minutes Post-contrast VACUUM-ASSISTED ASSISTED BREAST BIOPSY Developed to increase yield for histology Automated vacuum-assisted assisted core biopsies, needle size Fr 14

15 VACUUM-ASSISTED ASSISTED BREAST BIOPSY Placement guided by mammography (stereotactic), US or MRI VACUUM-ASSISTED ASSISTED BREAST BIOPSY 15

VACUUM-ASSISTED ASSISTED BREAST BIOPSY Advantages: large sample size, single needle placement Disadvantages: cost ($20,000/yr at VGH), time, trauma SUMMARY Accurate and reliable breast biopsy can be

16 VACUUM-ASSISTED ASSISTED BREAST BIOPSY Advantages: large sample size, single needle placement Disadvantages: cost ($20,000/yr at VGH), time, trauma SUMMARY Accurate and reliable breast biopsy can be performed using stereotactic,, US or MRI guidance All biopsy results must be correlated with imaging. If results are not concordant - follow up! Radiologist should be responsible for initiating, performing and auditing results of image guided breast biopsy 16

17 US GUIDED BREAST BIOPSY 17

STEREOTACTIC BREAST BIOPSY: CORRELATION WITH HISTOLOGY

STEREOTACTIC BREAST BIOPSY: CORRELATION WITH HISTOLOGY 3-rd Baltic Congress of Radiology, October 8-9, 2010 Riga Rūta Briedienė, Rūta Grigienė, Raimundas Meškauskas Institute of Oncology Vilnius University, National Centre of Pathology STEREOTACTIC BREAST