Minimally Invasive Breast Biopsies

1 Documentation and Correlation of Senologic Findings.............................................. 1
Renzo Brun del Re
1.1 Introduction...................................................................................................... 1
1.2 Senometry........................................................................................................ 1
1.2.1
Material............................................................................................................ 1
1.3 Mapping Clinical Findings............................................................................... 1
1.4 Mapping Mammographic Lesions Smaller than 2 cm..................................... 3
1.4.1 Mapping the Lesion on the Mammogram........................................................ 3
1.4.2 Transferring the Mammographic Dimensions onto the Breast........................ 7
1.5 Intraoperative Senometric Needle Localization............................................... 15
1.6 Mapping Mammographic Lesions Larger than 2 cm....................................... 15
1.6.1 Mapping the Lesion on the Mammogram........................................................ 15
1.6.2 Transferring Dimensions onto the Breast........................................................ 17
1.7 Nonpalpable Lesion Detected by Ultrasound.................................................. 19
1.8 Advantages of Senometry................................................................................ 21
References..............................................................................................................
.......... 21
2 Comparison of Large-Core Vacuum-Assisted Breast Biopsy
and Excision
Systems...................................................................................................... 23
Robin Wilson and Sanjay Kavia
2.1 Introduction......................................................................................................
23
2.2 Large-Core Biopsy Systems: Overview........................................................... 24
2.2.1 Single Large-Core Biopsy System................................................................... 24
2.2.2 Vacuum-Assisted Mammotomy Systems......................................................... 26
2.3 Indications and Limitations.............................................................................. 35
2.3.1
Limitations....................................................................................................... 36
2.3.2 Diagnostic Biopsy............................................................................................ 37
2.3.3 Therapeutic Excision....................................................................................... 38
2.3.4 Image-Guided Biopsy Technique..................................................................... 39
Contents
v
vi Contents
2.4 Conclusions...................................................................................................... 40
References..............................................................................................................
.......... 40
3 Sonographically Guided Vacuum-Assisted Breast Biopsy Using
Handheld Mammotome................................................................................................ 43
Luc Steyaert, Filip Van Kerkhove, and Jan W. Casselman
3.1 Introduction......................................................................................................
43
3.2 Equipment........................................................................................................ 43
3.3 Technique.........................................................................................................
48
3.4 Indications........................................................................................................
67
3.4.1 Probably Benign or Indeterminate Nodular Lesions........................................ 68
3.4.2 Very Small Suspicious Lesions........................................................................ 70
3.4.3 Areas of Localized Attenuation....................................................................... 72
3.4.4 Isolated, Complex Fibrocystic Areas................................................................ 73
3.4.5
Papillomas........................................................................................................ 75
3.4.6 Clusters of Microcalcifications........................................................................ 76
3.4.7 Lesions in Difficult Locations......................................................................... 82
3.4.8 Very Hard Lesions with Inconclusive Previous Biopsy or FNAC................... 82
3.4.9 Inadequate FNAC or Microbiopsy Results...................................................... 82
3.4.10 Removal of Benign Lesions............................................................................. 82
3.4.11 Indications Discussed: Radial Scar, Large Intracystic Lesions........................ 83
3.4.12 Other Indications..............................................................................................
85
3.5 Processing the Cores........................................................................................ 85
3.6 Needle Size...................................................................................................... 88
3.7 Clip Placement................................................................................................. 90
3.8 US Versus Mammographic Guidance.............................................................. 90
3.9
Results.............................................................................................................. 92
References..............................................................................................................
.......... 93
4 The Vacora Biopsy
System.............................................................................................. 97
R. Schulz-Wendtland
4.1 Introduction......................................................................................................
97
4.2 Technique.........................................................................................................
97
4.3 Indications and Contraindications.................................................................... 98
4.3.1 US-Guided Transcutaneous Vacuum Biopsy................................................... 98
4.3.2 Stereotactic Vacuum Biopsy............................................................................ 101
4.3.3 MRI-Guided Vacuum Biopsy........................................................................... 101
4.4 Side Effects......................................................................................................
101
4.5
Results..............................................................................................................
101
4.6 Limitations.......................................................................................................
102
4.7 Practical Hints..................................................................................................
102
References..............................................................................................................
.......... 102
Contents vii
5 Available Stereotactic Systems for Breast Biopsy......................................................... 105
Ossi R. K?hli
5.1 Introduction......................................................................................................
105
5.1.1 Prone Position Techniques............................................................................... 105
5.1.2 Upright Systems............................................................................................... 109
5.2 Cost of the Systems.......................................................................................... 112
5.3 Cost of the Procedures..................................................................................... 112
References..............................................................................................................
.......... 113
6 MRI-Guided Minimally Invasive Breast Procedures................................................... 115
Harald Marcel Bonel
6.1 Introduction: Role of MR Mammography....................................................... 115
6.1.1
Indications........................................................................................................ 116
6.1.2 Technique and Practical Tips............................................................................ 117
6.1.3
Limitations....................................................................................................... 126
6.2 Conclusion.......................................................................................................
128
References..............................................................................................................
.......... 128
7 Ductoscopy of Intraductal Neoplasia of the Breast...................................................... 129
Michael H?erbein, Matthias Raubach, Y.Y. Dai, and Peter M. Schlag
7.1 Introduction......................................................................................................
129
7.2 Methods for Sampling Intraductal Breast Cells............................................... 129
7.2.1 Technique of Ductoscopy................................................................................. 130
7.2.2 Ductoscopic Biopsy......................................................................................... 132
7.2.3 Ductoscopy in Women with Nipple Discharge................................................ 132
7.2.4 Ductoscopy in Breast Cancer........................................................................... 133
7.3 Summary..........................................................................................................
134
References..............................................................................................................
.......... 134
8 Pathology of Breast Tissue Obtained in Minimally Invasive
Biopsy
Procedures...........................................................................................................
137
Gad Singer and Sylvia Stadlmann
8.1 Introduction......................................................................................................
137
8.2 Pathology of Breast Disease in Minimally Invasive Biopsies.......................... 137
8.3 Benign Epithelial Lesions................................................................................ 138
8.3.1 Periductal Mastitis............................................................................................
138
8.3.2 Fibrocystic Change.......................................................................................... 138
8.3.3 Sclerosing Adenosis......................................................................................... 139
8.3.4 Columnar Cell Lesions.................................................................................... 140
8.3.5 Usual-Type Epithelial Hyperplasia.................................................................. 140
8.3.6 Lobular Neoplasia............................................................................................ 141
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8.4 Fibroepithelial Lesions..................................................................................... 142
8.4.1 Fibroadenoma...................................................................................................
142
8.4.2 Phyllodes Tumor............................................................................................... 143
8.4.3 Benign Papillary Lesions................................................................................. 143
8.5 Malignant Noninvasive Lesions....................................................................... 144
8.6 Invasive Carcinoma.......................................................................................... 145
8.7 Grading of Breast Carcinoma.......................................................................... 146
8.8 Predictive Factors in MIBS.............................................................................. 147
References..............................................................................................................
.......... 147
9 Limitations of Minimally Invasive Breast Biopsy......................................................... 149
Mathias K. Fehr
9.1 Technical Failures............................................................................................. 149
9.2 Underestimation of Breast Pathology on Minimally
Invasive Breast Biopsy Specimens................................................................... 149
References..............................................................................................................
.......... 155
10 Advances in Breast Imaging: A Dilemma or Progress?............................................... 159
Daniel Fl?y, Michael W. Fuchsjaeger, Christian F. Weisman,
and Thomas H. Helbich
10.1 Introduction......................................................................................................
159
10.2 Ultrasound........................................................................................................
159
10.2.1 Multiplanar Display Mode............................................................................... 161
10.2.2 Niche Mode View............................................................................................ 161
10.2.3 Surface Mode...................................................................................................
161
10.2.4 Transparency Mode.......................................................................................... 161
10.2.5 Static 3D Volume Contrast Imaging................................................................. 162
10.2.6 4D Volume Contrast Imaging........................................................................... 162
10.2.7 Inversion Mode................................................................................................
163
10.2.8 Volume Calculation.......................................................................................... 163
10.2.9 Tomographic Ultrasound Imaging................................................................... 163
10.2.10 Glass Body Rendering..................................................................................... 164
10.2.11 Power Doppler, Color Doppler, and High-Definition Flow............................. 164
10.2.12 Extended View Documentation........................................................................ 165
10.2.13
Conclusion....................................................................................................... 167
10.3 Magnetic Resonance Imaging.......................................................................... 167
10.3.1 1.5-Tesla Systems and Gadopentetate.............................................................. 167
10.3.2 3.0-Tesla Systems.............................................................................................
168
10.3.3 Macromolecular Contrast Agents.................................................................... 168
10.3.4 Tumor-Specific Contrast Agents...................................................................... 170
10.3.5 Functional Breast Imaging Techniques (Spectroscopy,
Diffusion-Weighted Imaging).......................................................................... 171
Contents ix
10.4 Positron Emission Tomography....................................................................... 172
10.4.1 Imaging of Cellular Proliferation and Apoptosis............................................. 172
10.4.2 Receptor Imaging............................................................................................. 173
10.5 Optical Imaging............................................................................................... 173
10.5.1 Imaging of Hemoglobin................................................................................... 174
10.5.2 CTLM Device.................................................................................................. 174
10.5.3 Optical Imaging of Extrinsic Contrast Agents................................................. 175
10.6 Electrical Impedance Scanning........................................................................ 176
10.6.1 Targeted EIS with TransScan TS2000.............................................................. 177
10.6.2 Screening EIS with T-Scan 2000ED................................................................ 179
10.7 Conclusion.......................................................................................................
180
References..............................................................................................................
.......... 180
11 Cost뺹enefit
Analyses..................................................................................................... 183
Renzo Brun del Re and Regula E. B?ki
11.1 Introduction......................................................................................................
183
11.2 Frequency of Mammography........................................................................... 183
11.3 Recall Rate.......................................................................................................
184
11.3.1 Recall Rate in Screening Programs.................................................................. 184
11.3.2 Recall Rate Outside of Screening Programs.................................................... 185
11.4 Distribution of Further Investigations.............................................................. 185
11.4.1 Open (Surgical) Biopsy.................................................................................... 185
11.4.2 Substitution of Open Biopsies......................................................................... 185
11.4.3 Substitution of Other Diagnostic Procedures................................................... 186
11.5 Trends and Scenarios....................................................................................... 187
11.6 Comparison of Costs........................................................................................ 187
11.6.1 Costs and Savings............................................................................................ 189
11.7 Decision Makers Have Changed...................................................................... 190
11.8 Conclusions......................................................................................................
192
References..............................................................................................................
.......... 192
12 Systematic Review and Meta-analysis of Recent Data................................................. 195
Renzo Brun del Re and Regula E. B?ki
12.1 Evidence for the Clinical Relevance of Minimally Invasive
Breast Biopsy................................................................................................... 195
12.1.1 Older Systematic Reviews............................................................................... 195
12.2 Literature Search Methods............................................................................... 195
12.2.1 Evidence on Performance................................................................................ 195
12.2.2 Evidence on Risks and Safety.......................................................................... 197
12.2.3 Presentation and Analysis of the Data.............................................................. 197
12.3 Presentation and Analysis of the Data.............................................................. 200
12.3.1 Evidence Used.................................................................................................
200
12.3.2
Results..............................................................................................................
207
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12.4 Safety of MIBB................................................................................................ 212
12.4.1 Open Biopsy as Gold Standard........................................................................ 212
12.4.2 Fourteen-G Core Biopsies and 11-G Vacuum-Assisted Biopsies.................... 212
12.4.3 Conclusions on the Safety of MIBB................................................................ 215
12.5 Quality of Life (HRQoL)................................................................................. 215
12.6 Summary and Discussion of the MIBB Data Presented.................................. 217
12.7 Conclusions......................................................................................................
220
References..............................................................................................................
.......... 222