Stereotactic Breast Biopsy: Pitfalls and Pearls

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Stereotactic Breast Biopsy: Pitfalls and Pearls Monica L. Huang, MD, Beatriz E. Adrada, MD, Rosalind Candelaria, MD, Deborah Thames, RT (R)(M)(QM), Debora Dawson, RT (R)(M), Wei T. Yang, MD Techniques in Vascular & Interventional Radiology Volume 17, Issue 1, Pages 32-39 (March 2014) DOI: 10.1053/j.tvir.2013.12.006 Copyright © 2014 Terms and Conditions

Figure 1 Sterile biopsy tray includes, from left to right, scalpel, probe guide, skin-cleansing sponge, syringes for administration of local anesthesia, tweezers, and gauze. Syringes contain (A) 3mL of 1% lidocaine buffered with sodium bicarbonate (9:1 mixture) for skin and subcutaneous anesthesia, (B) 10mL of 1% lidocaine with epinephrine buffered with sodium bicarbonate (9:1 mixture) for deep breast parenchyma anesthesia, and (C) 10mL of 1% lidocaine with epinephrine buffered with sodium bicarbonate (9:1 mixture) for deep breast parenchyma anesthesia to be administered via the probe (if possible). (Color version of figure is available online.) Techniques in Vascular & Interventional Radiology 2014 17, 32-39DOI: (10.1053/j.tvir.2013.12.006) Copyright © 2014 Terms and Conditions

Figure 2 Prone stereotactic biopsy table. (Color version of figure is available online.) Techniques in Vascular & Interventional Radiology 2014 17, 32-39DOI: (10.1053/j.tvir.2013.12.006) Copyright © 2014 Terms and Conditions

Figure 3 Stereotactic biopsy device attached to a mammography or tomosynthesis unit with the patient in the lateral decubitus position. (Color version of figure is available online.) Techniques in Vascular & Interventional Radiology 2014 17, 32-39DOI: (10.1053/j.tvir.2013.12.006) Copyright © 2014 Terms and Conditions

Figure 4 Selected single-slice craniocaudal images of tomosynthesis-guided stereotactic biopsy for architectural distortion. (A) Scout tomosynthesis target slice image. (B) Postbiopsy tomosynthesis slice image demonstrating successful biopsy of the lesion, with clip in place. Techniques in Vascular & Interventional Radiology 2014 17, 32-39DOI: (10.1053/j.tvir.2013.12.006) Copyright © 2014 Terms and Conditions

Figure 5 Images from biopsy performed using a prone stereotactic biopsy table with targeting calipers placed on the lesion. (A) Nonangle single target image. (B) Prefire image pair at −15° and +15° from midline. (C) Postfire image pair. (D) Images obtained immediately after clip deployment, with the needle still in the breast. (E) Mammograms obtained after clip deployment. Techniques in Vascular & Interventional Radiology 2014 17, 32-39DOI: (10.1053/j.tvir.2013.12.006) Copyright © 2014 Terms and Conditions

Figure 6 Breast bolstering to increase the thickness of the compressed breast tissue. (Color version of figure is available online.) Techniques in Vascular & Interventional Radiology 2014 17, 32-39DOI: (10.1053/j.tvir.2013.12.006) Copyright © 2014 Terms and Conditions

Figure 7 Double-paddle maneuver to increase the thickness of the compressed breast tissue. (Color version of figure is available online.) Techniques in Vascular & Interventional Radiology 2014 17, 32-39DOI: (10.1053/j.tvir.2013.12.006) Copyright © 2014 Terms and Conditions

Figure 8 Arm-through-the-hole maneuver to access posterior or superior breast tissue. (A) The patient holds on to the rail of a stepping stool for support using the hand on the affected side. (B) The affected arm is on a stand for support. (Color version of figure is available online.) Techniques in Vascular & Interventional Radiology 2014 17, 32-39DOI: (10.1053/j.tvir.2013.12.006) Copyright © 2014 Terms and Conditions

Figure 9 Specimen from stereotactic biopsy (A) and corresponding specimen radiograph (B). (Color version of figure is available online.) Techniques in Vascular & Interventional Radiology 2014 17, 32-39DOI: (10.1053/j.tvir.2013.12.006) Copyright © 2014 Terms and Conditions

Figure 10 Specimen cores from stereotactic biopsy (A) with area of calcifications inked for the pathologist (B). (Color version of figure is available online.) Techniques in Vascular & Interventional Radiology 2014 17, 32-39DOI: (10.1053/j.tvir.2013.12.006) Copyright © 2014 Terms and Conditions