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KEY FACTS
Terminology
Preprocedure
Procedure
Post Procedure
Outcomes
TERMINOLOGY
Definitions
Mammographically guided biopsy using 2 stereotactic images (taken at +15° and -15° angles) or 1 tomosynthesis series for targeting; patient seated or lateral decubitus position
Standard mammography tower + biopsy attachment
Pros: Existing equipment, ↑ access to posterior lesions, ↑ patient comfort, faster than prone
Cons: Vasovagal reactions, ↑ potential for patient motion
Vasovagal reaction rate: 7% for upright vs. 2% for prone (1 series)
Inferior approach not feasible directly: Requires lateral decubitus positioning, which is not always possible
Biopsy devices
14-g automated core needle biopsy (CNB)
↓ bleeding but ↑ false negatives
Vacuum-assisted needle biopsy (VAB)
7-g to 12-g; most often 9- or 11-g
Variable aperture and clip deployment methods
Pros: ↑ accuracy/calcification retrieval, ↓ underestimation of pathology
Cons: ↑ risk of bleeding
PREPROCEDURE
Indications
Contraindications
Getting Started
PROCEDURE
Patient Position/Location
Equipment Preparation
Procedure Steps
Findings and Reporting
Alternative Procedures/Therapies
POST PROCEDURE
Expected Outcome
Things to Do
Things to Avoid
OUTCOMES
Problems
Complications
Selected References
Bahl M et al: Comparison of upright digital breast tomosynthesis-guided versus prone stereotactic vacuum-assisted breast biopsy. Radiology. 181788, 2018
Jain A et al: Stereotactic core needle breast biopsy marker migration: an analysis of factors contributing to immediate marker migration. Eur Radiol. 27(11):4797-803, 2017
Omofoye TS et al: Implementation of upright digital breast tomosynthesis-guided stereotactic biopsy. Acad Radiol. 24(11):1451-5, 2017
Ruggirello I et al: Stereotactic vacuum-assisted breast biopsy: comparison between 11- and 8-gauge needles. Eur J Surg Oncol. 43(12):2257-60, 2017
monticciolo DL et al: Six-month short-interval imaging follow-up for benign concordant core needle biopsy of the breast: outcomes in 1444 cases with long-term follow-up. AJR Am J Roentgenol. 1-6, 2016
Mooney KL et al: Upgrade rates of high-risk breast lesions diagnosed on core needle biopsy: a single-institution experience and literature review. Mod Pathol. 29(12):1471-1484, 2016
Johnson JM et al: Breast cancer detection with short-interval follow-up compared with return to annual screening in patients with benign stereotactic or US-guided breast biopsy results. Radiology. 275(1):54-60, 2015
Schrading S et al: Digital breast tomosynthesis-guided vacuum-assisted breast biopsy: initial experiences and comparison with prone stereotactic vacuum-assisted biopsy. Radiology. 274(3):654-62, 2015
Ohsumi S et al: Breast biopsy for mammographically detected nonpalpable lesions using a vacuum-assisted biopsy device (Mammotome) and upright-type stereotactic mammography unit without a digital imaging system: experience of 500 biopsies. Breast Cancer. 21(2):123-7, 2014
Mahoney MC et al: Breast intervention: how I do it. Radiology. 268(1):12-24, 2013
Viala J et al: Stereotactic vacuum-assisted biopsies on a digital breast 3D-tomosynthesis system. Breast J. 19(1):4-9, 2013
Becker DE et al: Local anesthetics: review of pharmacological considerations. Anesth Prog. 59(2):90-101; quiz 102-3, 2012
Gümüş H et al: Causes of failure in removing calcium in microcalcification-only lesions using 11-gauge stereotactic vacuum-assisted breast biopsy. Diagn Interv Radiol. 18(4):354-9, 2012
Schaefer FK et al: Interventional bleeding, hematoma and scar-formation after vacuum-biopsy under stereotactic guidance: Mammotome(®)-system 11 g/8 g vs. ATEC(®)-system 12 g/9 g. Eur J Radiol. 81(5):e739-45, 2012
Ames V et al: Stereotactically guided breast biopsy: a review. Insights Imaging. 2(2):171-176, 2011
Cummings DR et al: Complications of local anesthesia used in oral and maxillofacial surgery. Oral Maxillofac Surg Clin North Am. 23(3):369-77, 2011
Jung YJ et al: Lateral decubitus positioning stereotactic vacuum-assisted breast biopsy with true lateral mammography. J Breast Cancer. 14(1):64-8, 2011
Baldwin P: Breast biopsy targeting techniques. Radiol Technol. 82(1):59M-79M, 2010
Bruening W et al: Systematic review: comparative effectiveness of core-needle and open surgical biopsy to diagnose breast lesions. Ann Intern Med. 152(4):238-46, 2010
Neal JM et al: ASRA practice advisory on local anesthetic systemic toxicity. Reg Anesth Pain Med. 35(2):152-61, 2010
Ma K et al: A new lateral guidance device for stereotactic breast biopsy using an add-on unit to an upright mammography system. Conf Proc IEEE Eng Med Biol Soc. 2008:3653-6, 2008
Sim LS et al: Upright stereotactic vacuum-assisted needle biopsy of suspicious breast microcalcifications. J Med Imaging Radiat Oncol. 52(4):358-64, 2008
Somerville P et al: Anticoagulation and bleeding risk after core needle biopsy. AJR Am J Roentgenol. 191:1194-7, 2008
Fahrbach K et al: A comparison of the accuracy of two minimally invasive breast biopsy methods: a systematic literature review and meta-analysis. Arch Gynecol Obstet. 274(2):63-73, 2006
Uriburu JL et al: Local recurrence of breast cancer after skin-sparing mastectomy following core needle biopsy: case reports and review of the literature. Breast J. 12(3):194-8, 2006
Yazici B et al: Scar formation after stereotactic vacuum-assisted core biopsy of benign breast lesions. Clin Radiol. 61(7):619-24, 2006
James JJ et al: The use of a short-acting benzodiazepine to reduce the risk of syncopal episodes during upright stereotactic breast biopsy. Clin Radiol. 60(3):394-6, 2005
Koskela AK et al: Add-on device for stereotactic core-needle breast biopsy: how many biopsy specimens are needed for a reliable diagnosis? Radiology. 236(3):801-9, 2005
McLure HA et al: Review of local anaesthetic agents. Minerva Anestesiol. 71(3):59-74, 2005
Della Sala SW et al: Advantages and limits of percutaneous breast core biopsy with Mammotome and stereotactic equipment in upright seated patient. Radiol Med. 108(4):335-44, 2004
Esserman LE et al: Recognizing pitfalls in early and late migration of clip markers after imaging-guided directional vacuum-assisted biopsy. Radiographics. 24(1):147-56, 2004
Lomoschitz FM et al: Stereotactic 11-gauge vacuum-assisted breast biopsy: influence of number of specimens on diagnostic accuracy. Radiology. 232(3):897-903, 2004
Margolin FR et al: Metallic marker placement after stereotactic core biopsy of breast calcifications: comparison of two clips and deployment techniques. AJR Am J Roentgenol. 181(6):1685-90, 2003
Achar S et al: Principles of office anesthesia: part I. Infiltrative anesthesia. Am Fam Physician. 66(1):91-4, 2002
Kass R et al: Clip migration in stereotactic biopsy. Am J Surg. 184(4):325-31, 2002
Meloni GB et al: Percutaneous vacuum-assisted core breast biopsy with upright stereotactic equipment. Indications, limitations and results. Acta Radiol. 43(6):575-8, 2002
Sittek H et al: [Stereotactic vacuum biopsy in prone and sitting position.] Radiologe. 42(1):19-24, 2002
Wunderbaldinger P et al: Comparison of sitting versus prone position for stereotactic large-core breast biopsy in surgically proven lesions. AJR Am J Roentgenol. 178(5):1221-5, 2002
Becker L et al: Stereotactic core biopsy of breast microcalcifications: comparison of film versus digital mammography, both using an add-on unit. AJR Am J Roentgenol. 177(6):1451-7, 2001
Pisano ED et al: Fine-needle aspiration biopsy of nonpalpable breast lesions in a multicenter clinical trial: results from the radiologic diagnostic oncology group V. Radiology. 219(3):785-92, 2001
Sneige N et al: Accuracy of cytologic diagnoses made from touch imprints of image-guided needle biopsy specimens of nonpalpable breast abnormalities. Diagn Cytopathol. 23(1):29-34, 2000
Keyes PD et al: Topical anesthesia. Can Fam Physician. 44:2152-6, 1998
Lankford KV et al: Utilization of core wash material in the diagnosis of breast lesions by stereotactic needle biopsy. Cancer. 84(2):98-100, 1998
Meechan J: How to avoid local anaesthetic toxicity. Br Dent J. 184(7):334-5, 1998
Burbank F et al: Tissue marking clip for stereotactic breast biopsy: initial placement accuracy, long-term stability, and usefulness as a guide for wire localization. Radiology. 205(2):407-15, 1997
Burbank F: Mammographic findings after 14-gauge automated needle and 14-gauge directional, vacuum-assisted stereotactic breast biopsies. Radiology. 204(1):153-6, 1997
Fuhrman G et al: Stereotactic core needle breast biopsy is an accurate diagnostic technique to assess nonpalpable mammographic abnormalities. J La State Med Soc. 148(4):167-70, 1996
Parker SH et al: Nonpalpable breast lesions: stereotactic automated large-core biopsies. Radiology. 180(2):403-7, 1991
Lofgren M et al: Stereotactic fine-needle aspiration for cytologic diagnosis of nonpalpable breast lesions. AJR Am J Roentgenol. 154(6):1191-5, 1990
Parker SH et al: Stereotactic breast biopsy with a biopsy gun. Radiology. 176(3):741-7, 1990
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References
Tables
Tables
KEY FACTS
Terminology
Preprocedure
Procedure
Post Procedure
Outcomes
TERMINOLOGY
Definitions
Mammographically guided biopsy using 2 stereotactic images (taken at +15° and -15° angles) or 1 tomosynthesis series for targeting; patient seated or lateral decubitus position
Standard mammography tower + biopsy attachment
Pros: Existing equipment, ↑ access to posterior lesions, ↑ patient comfort, faster than prone
Cons: Vasovagal reactions, ↑ potential for patient motion
Vasovagal reaction rate: 7% for upright vs. 2% for prone (1 series)
Inferior approach not feasible directly: Requires lateral decubitus positioning, which is not always possible
Biopsy devices
14-g automated core needle biopsy (CNB)
↓ bleeding but ↑ false negatives
Vacuum-assisted needle biopsy (VAB)
7-g to 12-g; most often 9- or 11-g
Variable aperture and clip deployment methods
Pros: ↑ accuracy/calcification retrieval, ↓ underestimation of pathology
Cons: ↑ risk of bleeding
PREPROCEDURE
Indications
Contraindications
Getting Started
PROCEDURE
Patient Position/Location
Equipment Preparation
Procedure Steps
Findings and Reporting
Alternative Procedures/Therapies
POST PROCEDURE
Expected Outcome
Things to Do
Things to Avoid
OUTCOMES
Problems
Complications
Selected References
Bahl M et al: Comparison of upright digital breast tomosynthesis-guided versus prone stereotactic vacuum-assisted breast biopsy. Radiology. 181788, 2018
Jain A et al: Stereotactic core needle breast biopsy marker migration: an analysis of factors contributing to immediate marker migration. Eur Radiol. 27(11):4797-803, 2017
Omofoye TS et al: Implementation of upright digital breast tomosynthesis-guided stereotactic biopsy. Acad Radiol. 24(11):1451-5, 2017
Ruggirello I et al: Stereotactic vacuum-assisted breast biopsy: comparison between 11- and 8-gauge needles. Eur J Surg Oncol. 43(12):2257-60, 2017
monticciolo DL et al: Six-month short-interval imaging follow-up for benign concordant core needle biopsy of the breast: outcomes in 1444 cases with long-term follow-up. AJR Am J Roentgenol. 1-6, 2016
Mooney KL et al: Upgrade rates of high-risk breast lesions diagnosed on core needle biopsy: a single-institution experience and literature review. Mod Pathol. 29(12):1471-1484, 2016
Johnson JM et al: Breast cancer detection with short-interval follow-up compared with return to annual screening in patients with benign stereotactic or US-guided breast biopsy results. Radiology. 275(1):54-60, 2015
Schrading S et al: Digital breast tomosynthesis-guided vacuum-assisted breast biopsy: initial experiences and comparison with prone stereotactic vacuum-assisted biopsy. Radiology. 274(3):654-62, 2015
Ohsumi S et al: Breast biopsy for mammographically detected nonpalpable lesions using a vacuum-assisted biopsy device (Mammotome) and upright-type stereotactic mammography unit without a digital imaging system: experience of 500 biopsies. Breast Cancer. 21(2):123-7, 2014
Mahoney MC et al: Breast intervention: how I do it. Radiology. 268(1):12-24, 2013
Viala J et al: Stereotactic vacuum-assisted biopsies on a digital breast 3D-tomosynthesis system. Breast J. 19(1):4-9, 2013
Becker DE et al: Local anesthetics: review of pharmacological considerations. Anesth Prog. 59(2):90-101; quiz 102-3, 2012
Gümüş H et al: Causes of failure in removing calcium in microcalcification-only lesions using 11-gauge stereotactic vacuum-assisted breast biopsy. Diagn Interv Radiol. 18(4):354-9, 2012
Schaefer FK et al: Interventional bleeding, hematoma and scar-formation after vacuum-biopsy under stereotactic guidance: Mammotome(®)-system 11 g/8 g vs. ATEC(®)-system 12 g/9 g. Eur J Radiol. 81(5):e739-45, 2012
Ames V et al: Stereotactically guided breast biopsy: a review. Insights Imaging. 2(2):171-176, 2011
Cummings DR et al: Complications of local anesthesia used in oral and maxillofacial surgery. Oral Maxillofac Surg Clin North Am. 23(3):369-77, 2011
Jung YJ et al: Lateral decubitus positioning stereotactic vacuum-assisted breast biopsy with true lateral mammography. J Breast Cancer. 14(1):64-8, 2011
Baldwin P: Breast biopsy targeting techniques. Radiol Technol. 82(1):59M-79M, 2010
Bruening W et al: Systematic review: comparative effectiveness of core-needle and open surgical biopsy to diagnose breast lesions. Ann Intern Med. 152(4):238-46, 2010
Neal JM et al: ASRA practice advisory on local anesthetic systemic toxicity. Reg Anesth Pain Med. 35(2):152-61, 2010
Ma K et al: A new lateral guidance device for stereotactic breast biopsy using an add-on unit to an upright mammography system. Conf Proc IEEE Eng Med Biol Soc. 2008:3653-6, 2008
Sim LS et al: Upright stereotactic vacuum-assisted needle biopsy of suspicious breast microcalcifications. J Med Imaging Radiat Oncol. 52(4):358-64, 2008
Somerville P et al: Anticoagulation and bleeding risk after core needle biopsy. AJR Am J Roentgenol. 191:1194-7, 2008
Fahrbach K et al: A comparison of the accuracy of two minimally invasive breast biopsy methods: a systematic literature review and meta-analysis. Arch Gynecol Obstet. 274(2):63-73, 2006
Uriburu JL et al: Local recurrence of breast cancer after skin-sparing mastectomy following core needle biopsy: case reports and review of the literature. Breast J. 12(3):194-8, 2006
Yazici B et al: Scar formation after stereotactic vacuum-assisted core biopsy of benign breast lesions. Clin Radiol. 61(7):619-24, 2006
James JJ et al: The use of a short-acting benzodiazepine to reduce the risk of syncopal episodes during upright stereotactic breast biopsy. Clin Radiol. 60(3):394-6, 2005
Koskela AK et al: Add-on device for stereotactic core-needle breast biopsy: how many biopsy specimens are needed for a reliable diagnosis? Radiology. 236(3):801-9, 2005
McLure HA et al: Review of local anaesthetic agents. Minerva Anestesiol. 71(3):59-74, 2005
Della Sala SW et al: Advantages and limits of percutaneous breast core biopsy with Mammotome and stereotactic equipment in upright seated patient. Radiol Med. 108(4):335-44, 2004
Esserman LE et al: Recognizing pitfalls in early and late migration of clip markers after imaging-guided directional vacuum-assisted biopsy. Radiographics. 24(1):147-56, 2004
Lomoschitz FM et al: Stereotactic 11-gauge vacuum-assisted breast biopsy: influence of number of specimens on diagnostic accuracy. Radiology. 232(3):897-903, 2004
Margolin FR et al: Metallic marker placement after stereotactic core biopsy of breast calcifications: comparison of two clips and deployment techniques. AJR Am J Roentgenol. 181(6):1685-90, 2003
Achar S et al: Principles of office anesthesia: part I. Infiltrative anesthesia. Am Fam Physician. 66(1):91-4, 2002
Kass R et al: Clip migration in stereotactic biopsy. Am J Surg. 184(4):325-31, 2002
Meloni GB et al: Percutaneous vacuum-assisted core breast biopsy with upright stereotactic equipment. Indications, limitations and results. Acta Radiol. 43(6):575-8, 2002
Sittek H et al: [Stereotactic vacuum biopsy in prone and sitting position.] Radiologe. 42(1):19-24, 2002
Wunderbaldinger P et al: Comparison of sitting versus prone position for stereotactic large-core breast biopsy in surgically proven lesions. AJR Am J Roentgenol. 178(5):1221-5, 2002
Becker L et al: Stereotactic core biopsy of breast microcalcifications: comparison of film versus digital mammography, both using an add-on unit. AJR Am J Roentgenol. 177(6):1451-7, 2001
Pisano ED et al: Fine-needle aspiration biopsy of nonpalpable breast lesions in a multicenter clinical trial: results from the radiologic diagnostic oncology group V. Radiology. 219(3):785-92, 2001
Sneige N et al: Accuracy of cytologic diagnoses made from touch imprints of image-guided needle biopsy specimens of nonpalpable breast abnormalities. Diagn Cytopathol. 23(1):29-34, 2000
Keyes PD et al: Topical anesthesia. Can Fam Physician. 44:2152-6, 1998
Lankford KV et al: Utilization of core wash material in the diagnosis of breast lesions by stereotactic needle biopsy. Cancer. 84(2):98-100, 1998
Meechan J: How to avoid local anaesthetic toxicity. Br Dent J. 184(7):334-5, 1998
Burbank F et al: Tissue marking clip for stereotactic breast biopsy: initial placement accuracy, long-term stability, and usefulness as a guide for wire localization. Radiology. 205(2):407-15, 1997
Burbank F: Mammographic findings after 14-gauge automated needle and 14-gauge directional, vacuum-assisted stereotactic breast biopsies. Radiology. 204(1):153-6, 1997
Fuhrman G et al: Stereotactic core needle breast biopsy is an accurate diagnostic technique to assess nonpalpable mammographic abnormalities. J La State Med Soc. 148(4):167-70, 1996
Parker SH et al: Nonpalpable breast lesions: stereotactic automated large-core biopsies. Radiology. 180(2):403-7, 1991
Lofgren M et al: Stereotactic fine-needle aspiration for cytologic diagnosis of nonpalpable breast lesions. AJR Am J Roentgenol. 154(6):1191-5, 1990
Parker SH et al: Stereotactic breast biopsy with a biopsy gun. Radiology. 176(3):741-7, 1990
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