Technical Challenges in Image-Guided Breast Biopsy

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification for enrollments starting after March 18, 2024:

Breast Sonography: 2.00
Procedures: 2.00
Breast Interventions: 2.00

Mammography: 2.00
Procedures: 2.00
Mammographic Positioning, Special Needs, and Imaging Procedures: 2.00

Magnetic Resonance Imaging: 2.00
Procedures: 2.00
Body: 2.00

Registered Radiologist Assistant: 2.00
Procedures: 2.00
Thoracic Section: 2.00

Sonography: 2.00
Procedures: 2.00
Superficial Structures and Other Sonographic Procedures: 2.00

Outline

1. Introduction
2. Planning Image-guided Breast Biopsy
3. Technical Challenges: Patient Factors
   1. Patient Comorbidities
   2. Anticoagulation
   3. Thin Breast
   4. Brest Implants
4. Technical Challenges: Lesion Factors
   1. Conspicuity of Target
   2. Location of Target
      1. Posterior or Deep Target
      2. Superficial Target
      3. Axillary Target
      4. Subareolar Target
5. Multimodality Target Correlation
6. Cancellation of Image-guided Breast Biopsy
7. Conclusion

Objectives

Upon completion of this course, students will:

1. compare open surgical breast biopsy to image-guided breast biopsy
2. list the types of image-guided breast biopsies that can be performed
3. list the basic steps involved with stereotactic breast biopsy
4. state the patient position for stereotactic breast biopsy
5. state the patient position for US-guided breast biopsy
6. describe the patient’s arm position for US-guided breast biopsy
7. recall the most expensive modality for breast biopsy
8. explain the importance of pre-procedural review of diagnostic images and clinical information
9. recall the best stereotactic approach for targets seen in the craniocaudal projection
10. list the reasons making US the most commonly used modality for breast biopsy
11. match the imaging modality that must be used for targets seen only at MR breast imaging
12. list the factors that may limit a patient’s ability to have an image-guided breast biopsy
13. recall the minimum breast thickness for standard needle use in stereotactic breast biopsy
14. recall the minimum breast thickness for a shortened sampling chamber needle in MR-guided breast biopsy
15. choose the best breast specimen option for thin-breasted women
16. list the options utilized during stereotactic breast biopsy that can help thicken the breast
17. state the position of the sampling chamber for vacuum-assisted needle biopsy
18. recall the techniques used to ensure an adequate vacuum seal for safe needle-guided biopsy
19. explain the necessary location for breast implants to avoid rupture
20. list the tools used to help identify small or subtle targets before breast biopsy
21. list landmarks used in MR breast imaging to help identify the intended target for biopsy
22. state the important success factors when targeting a lesion in the posterior breast when using prone stereotactic-guided biopsy
23. choose the technique used to better access lesions in the posterior breast and axillary tail
24. list the advantages of a stereotactic breast biopsy “fitting”
25. recall the technique used in MR breast biopsy for accessing a posterior lesion
26. state the entry site for US breast biopsy of posterior targets
27. choose the needle device best suited for superficial breast targets being accessed via US guidance
28. state the sampling chamber size required for stereotactic or MR guided biopsy of a superficial breast target
29. list the structures to be avoided in the axilla during axillary breast biopsy
30. compare cost and comfort of US-guided biopsy to MR-guided biopsy
31. state the percent of accuracy of accessing sub-areolar calcifications when utilizing a high-frequency US probe
32. list imaging characteristics of lesions found at MR imaging that increase the likelihood of identifying a US correlate
33. describe follow up needed for nonspecific benign concordant pathology results when the MR imaging lesion was biopsied under US guidance
34. state the MR sequence that helps increase confidence in the correlation of lesions initially identified at MR imaging and biopsied with stereotactic or US guidance
35. state the cancellation rate for stereotactic-guided breast biopsy
36. name the most common reason for stereotactic-guided breast biopsy cancellation
37. state the options when stereotactic-guided breast biopsy cannot be performed
38. state the overall cancellation rate for MR imaging-guided biopsy for lesion non-identification at the time of biopsy
39. recall the most common MR imaging finding that is not identified at the time of MR imaging-guided biopsy
40. state alternate techniques to help visualize targets not previously enhanced at attempted MR imaging-guided biopsy