How to do DBT-biopsy: A Film from the Practice

Hello. I'm going to show you how to perform a Tomo guided biopsy using the lateral arm. This is the biopsy table which allows you to perform both stereotactic or thermal guided biopsies. And now we are positioning the patient just in front of the mammograph. First, we are going to acquire and scout image to show this time a cluster of microcalcifications. They were very, very tiny. In this case we repeat it again the scout image. And here are the microcalcifications. OK, now we are going to perform. Automobile acquisition. And now we have to make click where the cluster of microcalcifications is. Here it is, this is the tumor localization. And this is very simple because you only have to confirm the coordinates and send them to the system and you can start with the biopsy procedure. We use lidocaine mixed with bicarbonate. For this procedure, we are going to use the lateral arm that allows a very comfortable positioning for the patient. And it's a very good option for the lesions located in the inner or outer quadrants like this case. Now it is time to inject the local anesthetic. First, we start with the subcutaneous needle. And then? We inject deeply the anesthetic. With an intramuscular needle. It is interesting to bend the needle to facilitate the injection of the anesthetic. As you can see. The patient can be talking with a nurse. And. She can feel comfortable. Next step is to introduce the biopsy needle into the breast. And. A pair of stereotactic images must be acquired. These are the prefire images in order to check. If the Microcalcifications are located just in the tip of the needle, like in this case. Then we can fire. The system and again another pair of stereotactic images can be acquired. So that we can check again the position of the Microcalcifications very close to the nil. And we can start immediately. With the vacuum assisted biopsy. Additional anesthetic was required and could be. Inject it through the biopsy needle. So we continued with the biopsy. As all of you know, these vacuum assisted biopsy systems are directional systems, so we can direct the acquisition chamber. To the quadrant where the calcifications of the lycium is, we routinely obtain 6 to 12 specimens and it is very interesting with this system that we can perform specimen radiograph while the procedure without removing the needle biopsy and now you can see how we are performing and 1st specimen radiograph. The so-called inspect in order to check if there are microcalcifications in the specimen radiograph. Now we are obtaining in aspect. And as you can see. There are only quite a few microcalcifications, not enough for a good diagnosis. So we have to continue with the biopsy. OK, no problem. And finally we obtain more specimens and again a new inspect image. Is obtained in order to check the presence of more microcalcifications. Finally. And marker. Was deployed after the biopsy. And the procedure is finished.

00 12 11 01 02 03 06 07 Clínica Universidad de Navarra STV NIV ORVA Scale 311% o.p. Initial scout view KV: 28 mAs: 189.1 mAs Angle: -0.1 Focus: large Comp. Force: 34 N Slice Height: 61 mm of 62 mm Anode/Filter: W/Rh Entrance Dose: 7.6 mGy Glandular Dose: 2.86 mby Slice Thickne Station: MAM Slice Thickness: 1 mm t: 34 mm of 62 mm Slice Height: 33 mm of 62 mm Inst Force: 34 N Station: MA Station: MAMM Focus: la Operat Station: MAMMOMAT-PC Tomo localization kV: 28 Slice Height: 30 mm of 62 mm Glandular Dose: 2.86 mGy Operator: Institution: Clinca Universidad de ... 36 PIO XII Pamplona District 31 ... Clinica MENS e Nav rsi ava Ma si Anesthetic Marker sidad varra línica Jnive Jniversidad UNLOCK HOLD TO Pre-fire images non Scale 278% o.p. Examination Post-fire images Ultrasound 10G Sample BARD Options Count ENSPIRE Cutter is Sampling. Please wait. VAC Cutter is closed. To open press SAMPLE handswitch/footswitch. To vacuum press VAC handswitch/footswitch. rra Anesthe Cutter is opening. Please wait. STOP Initial InSpect image Additional InSpect images Clin ca SIEMENS ersidad avarra ERSITAS RV NIVERSITAS Universidad www.cun.es