Introduction to Different Biopsy Methods

Well, the first question is what is the guiding method of choice to perform a breast biopsy ultrasound? Stereotaxis. Double synthesis or MRI? Well, for me and for the vast majority of radiologists. The the answer is very clear. The choice is ultrasound. In fact, ultrasound has become the choice for lesions visible on ultrasound and the most widespread used technique to guide a biopsy. It has a lot of advantages. First, the control of the needle position in real time, the excellent comfort for patients and radiologists. The ultrasound equipment is more readily available than stereotactic or MRI units. The local anesthesia does not hide the lesion, even it can be used to move the lesion to a better position. Depressed is not compressed. Multiple lesions, unilateral, bilateral can be biopsied in one session. The peripheral lesions are amenable to the technique. Including the axilla. Conventional 14 gates, cornyval biopsy systems. Offer good results and finally, it's a cost. Effective and fast technique. This is how the system works. You know it perfectly, the conventional throughut systems. Here we injected local anesthesia. And the procedure is performing an outpatient setting. We can acquire a prefire and post fire images showing the full control of the needle position in real time, so the results are excellent with ultrasound. But there are some limitations because it is an operator depending technique. And ultrasound guided biopsy can be very difficult or even impossible in some cases, for instance if the lesions are not visible on ultrasound, such as calcifications and some tiny architectural distortions. And some lesions deeply located in fatty breasts can also be very difficult to be biopsied under ultrasound. Calcifications. The vast majority of calcifications cannot be detected clearly on ultrasound, and we need other guiding methods. And the same happens with subtle architectural distortions. Some of these lesions. Half of these complex Histology, such as atypical ductal hyperplasia or ductal carcinoma inside. This is why. For many years ago, we have the stereotactic guidance. This system allows you to localize lesions detected in mammography and has excellent results for classifications. It's an accurate, reliable technique and well tolerated by patients. These are the principles of stereotactic localization we acquired through a pair of images. With a known angle minus 15 + 15 degrees and we have to make click in the same image in both the pair of images so that the system calculates the coordinates. It is very simple. And what about the new revelation on the stereotactic system? Well, it's a very easy biopsy table mounting because it is lightweight and fast. But perhaps the most outstanding future is the inspect box. This is an integrated specimen scanners that allows you to perform a specimen radiograph during the procedure. Before the needle is removed in order to check if there are calcifications in the specimen. We will show some examples. This is how we perform uh step tactic localization. First we acquire a scout image. In this case the calcifications are peripherally seated, so we have we need a new positioning. This positioning is OK. Fine. And then we acquire the two images minus 15 and plus 15. We have to make it click just in the same vision. And that's all to start with the procedure. We can acquire a brief fire image and a post fire image in order to see if there is some movement of the lesion regarding to the. To the needle. In this case, the situation of the microcalcifications is fine, so we can start. With it. Biopsy. And this is the inspect. Showing the calcifications. While the procedure is being performed. So we can stop with the procedure because the classifications have been removed. This is very interesting. And also we can acquire some images after the vacuum assisted biopsy in order to confirm that all the classifications have disappeared and a clip can be deployed. But there are some limitations, because noncalcified lesions can be obscured by local anesthetic or hematoma. Some peripherally located lesions can be out of the field of view and the biopsy is not possible. Some lesions cannot be visible in one of the stereotactic views. And the lesions only detected by DVT. Can be difficult or impossible to be biopsied under these guiding method. This is why today we have. Wide angle biopsy. Tomal. What are the main advantages? Well, this system combines the excellent quality of the TUMO images and the accuracy of the stereotactic platform. It is faster than the stereotactic guidance and easier because you only have to make click on the lesion. And there is no need to identify the same lesion in two stereotactic images. And it is also a well tolerated procedure. So we use the. Wide angle biopsy, which allows you to detect very very subtle lesions such as architectural distortions. Again, we have the same platform, the table mounting is just exactly the same. We also have the inspect system to perform the specimen radiograph. And. There is also a way to perform. A biopsy using. Uh, frame that indicates you where delusion is. This uh slide compares both the stereotactic biopsy workflow and. The workflow by using the wide angle biopsy. And what is interesting to see is that it is very simple to make click just where the lesion is. Let me show you some examples. Some calcifications and. It is very easy with the thermal system. Just make click. Where the lesion is. And that's all, because the coordinates are immediately generated calculated. Instead of a pair of images where you have. To be very sure that the same lesion is visible on both images. We can also acquire pre and post. Fire images to see if there is some movement. In this case you can see that the calcifications are correctly located and the needle is perfect the localization. And again, the inner aspect is perfect to demonstrate the presence of microcalcifications and the procedure can be finished. And a marker can be deployed. After the procedure. But still, there are some limitations because nonclassified lesions can be obscured by local anesthetic or hematoma during the procedure. And some peripherally located lesions can be out of the field of view. Of the system.

10 22 50 33 34 Ultrasound, Stereotactic and DBT Biopsy Speaker: Dr. Luis Javier Pina Insausti Breast Readiologist at the University of Navarra Pamplona, Spain 1- Introduction What is the guiding method of choice to perform a breast biopsy? Stereotaxy? Tomosynthesis? MRI? Insights Imaging (2011) 2:493-500 ULTRASOUND has become ... REVIEW Ultrasound-guided core-needle biopsy of breast lesions Luis Apesteguia . Luis Javier Pina . The choice for lesions visible on US . The most widespread used technique to guide a biopsy ULTRASOUND: Advantages 1. Control of the needle position in real time 2. Excellent comfort for patients and radiologists 3. US equipment is more readily available than stereotactic or MR units 4. Local anaesthesia does not hide the lesion 5. The breast is not compressed 6. Multiple lesions (unilateral/bilateral) can be biopsied in one session 7.Peripheral lesions are amenable to the technique 8. Conventional 14G CNB offers good results 9. Cost effective 10. Fast technique er The procedure is performed in an outpatient setting, with local anaesthesia and using the free hand technique LA523 VIN Pre-fire Post-fire NIA Full control of the needle position in real time ULTRASOUND: Limitations · Operator-depending technique · US-guided biopsy is very difficult or even impossible in some cases Lesions not visible on US (calcs, arch. distortions) Lesions deeply located in fatty breasts Thickn ADH DCIS 2- Stereotactic guidance Insights Imaging (2011) 2:171-176 DOI 10.1007/s13244-010-0064-1 Stereotactically guided breast biopsy: a review Victoria Ames . Peter D. Britton · It allows you to localize lesions detected in mammography · Excellent results for calcs Accurate, reliable technique . Well tolerated by patients Principle of Stereotactic localisation X-ray tube position -x Compression paddle Z axis X axis Receptor Scout Shift in position of lesion from one image to the other. The computer calculates the depth (Z) Stereotactic guided biopsy SIEMENS Fast preparation and easy targeting Easy biopsy table mounting InSpect Box Position specimen view · Integrated specimen scanner · Lightweight biopsy table with < 5kg . Position only once: in the case the specimen retrieval · Fast table mounting was unsuccessful · Image the specimen safely: with no direct radiation to · No need to remove detector cover the patient . No additional specimen scanner needed Siemens Healthineers, 2020 Healthineers Lesion. New positioning needed Fine Pre Post Images after vacuum biopsy Limitations . Non-calcified lesions can be obscured by local anaesthesia or hematoma Some peripherally located lesions can be out of the field of view Some lesions cannot be visible in one of the stereotactic views . Lesions only detected by DBT can be difficult or impossible 3- 50º Wide-Angle Biopsy Digital Breast Tomosynthesis- guided Vacuum-assisted Breast Biopsy: Initial Experiences and Radiology Comparison with Prone Stereotactic Vacuum-assisted Biopsy1 ORIGINAL RESEARCH BREAST IMAGING Simone Schrading, MD Martina Distelmaier, MD Purpose: To use digital breast tomosynthesis (DBT)-guided vacuum- Timm Dirrichs, MD assisted biopsy (VAB) to sample target lesions identified at Sabine Detering, MD full-field digital screening mammography and compare clin- Liv Brolund, MD ical performance with that of prone stereotactic (PS) VAB. Kevin Strobel, MD Materials and In this institutional review board-approved study. 205 Christiane K. Kuhl, MD Methods: patients with 216 mammographic findings suspicious for Advantages It combines the excellent quality of the tomo- images and the accuracy of the STX system Faster than Stereotactic guiding: Just make click on the lesion (no need to identify the lesion in two stereotactic images) · It is a well tolerated procedure 50º Wide-Angle Biopsy SIEMENS . Intuitive one-click targeting · Target setting with only one click at the respective tomosynthesis slice · White box indicates targetable area for preselected needle · High target accuracy of +/- 1 mm . Position only once: in the case the specimen retrieval was unsuccessful · Image the specimen safely: with no direct radiation to the patient · No additional specimen scanner needed Speed up your biopsy workflow Standard stereotactic biopsy workflow Prepare Stereo Pre- & post-fired stereo pairs Biopsy system patient targeting (optionally) Simplified workflow illustration. Workflows may vary in different countries and clinics. 50º Wide-Angle Biopsy workflow Tomo Instead of ... IDC + DCIS anaesthesia or hematoma during the procedure ations Stay tuned. eld Universidad Navarra NIVERSITA de Navarra Please note that the learning material is for training purposes only. For the proper use of the software or hardware, please always use the Operator Manual or Instructions for Use (hereinafter collectively "Operator Manual") issued by Siemens Healthineers. This material is to be used as training material only and shall by no means substitute the Operator Manual. Any material used in this training will not be updated on a regular basis and does not necessarily reflect the latest version of the software and hardware available at the time of the training. The Operator Manual shall be used as your main reference, in particular for relevant safety information like warnings and cautions. 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