Stereotactic Vacuum-Assisted Biopsies on a Digital Breast 3D-Tomosynthesis System

The purpose of this study was to describe our operating process and to report results of 118 stereotactic vacuum-assisted biopsies performed on a digital breast 3D-tomosynthesis system. From October 2009 to December 2010, 118 stereotactic vacuum assisted biopsies have been performed on a digital breast 3D-tomosynthesis system. Informed consent was obtained for all patients. A total of 106 patients had a lesion, six had two lesions. Sixty-one lesions were clusters of micro-calcifications, 54 were masses and three were architectural distortions. Patients were in lateral decubitus position to allow shortest skin-target approach (or sitting). Specific compression paddle, adapted on the system, performed, and graduated, allowing localization in X-Y. Tomosynthesis views define the depth of lesion. Graduated Coaxial localization kit determines the beginning of the biopsy window. Biopsies were performed with an ATEC-Suros, 9 Gauge handpiece. All biopsies, except one, have reached the lesions. Five hemorrhages were incurred in the process, but no interruption was needed. Eight breast hematomas, were all spontaneously resolved. One was an infection. About 40% of patients had a skin ecchymosis. Processing is fast, easy, and requires lower irradiation dose than with classical stereotactic biopsies. Histology analysis reported 45 benign clusters of micro-calcifications, 16 malignant clusters of micro-calcifications, 24 benign masses, and 33 malignant masses. Of 13 malignant lesions, digital 2D-mammography failed to detect eight lesions and underestimated the classification of five lesions. Digital breast 3D-tomosynthesis depicts malignant lesions not visualized on digital 2D-mammography. Development of tomosynthesis biopsy unit integrated to stereotactic system will permit histology analysis for suspicious lesions.