Fenster A, Surry K J M, Mills G R, Downey D B
Imaging Research Laboratory, Robarts Research Institute, P.O. Box 5015, 100 Perth Drive, London, Ont., Canada N6A 5K8.
Ultrasonics. 2004 Apr;42(1-9):769-74. doi: 10.1016/j.ultras.2003.11.004.
Stereotactic X-ray mammography (SM) and ultrasound (US) guidance are commonly used techniques for breast biopsy. While SM provides 3D targeting information and US provides real-time guidance, both techniques have limitations. SM is a long and uncomfortable procedure and the US guided procedure is inherently 2D, requiring a skilled physician for both safety and accuracy. We have developed a 3D US-guided biopsy system to integrate with SM. The dual modality breast biopsy system combines the advantages of both approaches with 3D US and SM targeting, near real-time 3D and real-time 2D US guidance, breast stabilisation and a confined needle trajectory. Our goal is to be able to biopsy a larger percentage of suspicious masses using ultrasound, by clarifying ambiguous structures with mammographic imaging. Using breast phantoms, we have shown that our ultrasound guided biopsy system was capable of targeting artificial lesions that were 3.2 mm in diameter, with a 96% success rate. Through this study, we also demonstrated that our system was equivalent to current clinical practice, for an in vitro biopsy task. Metal beads in known relative positions allowed us to determine the geometry of the SM system, so that stereotactic mammography could be registered to 3D US images. The target registration error was found to be 1.6 mm. This error was dominated by positioning error in the vertical direction (perpendicular to the film surface). As an adjunct to SM, we propose that 3D US could provide more complete imaging information for target identification and real-time monitoring of needle insertion, as well as providing a means for rapid confirmation of biopsy success.
立体定向乳腺X线摄影（SM）和超声（US）引导是乳腺活检常用的技术。虽然SM提供三维靶向信息，US提供实时引导，但这两种技术都有局限性。SM是一个漫长且令人不适的过程，而US引导的过程本质上是二维的，需要技术熟练的医生来确保安全和准确。我们开发了一种与SM集成的三维US引导活检系统。这种双模态乳腺活检系统结合了两种方法的优点，具备三维US和SM靶向、近实时三维和实时二维US引导、乳腺稳定以及受限的针道。我们的目标是通过乳腺X线成像澄清模糊结构，从而能够使用超声对更大比例的可疑肿块进行活检。使用乳腺模型，我们已经表明我们的超声引导活检系统能够靶向直径为3.2毫米的人工病变，成功率为96%。通过这项研究，我们还证明了我们的系统在体外活检任务中与当前临床实践相当。已知相对位置的金属珠使我们能够确定SM系统的几何形状，以便将立体定向乳腺X线摄影与三维US图像配准。发现目标配准误差为1.6毫米。该误差主要由垂直方向（垂直于胶片表面）的定位误差主导。作为SM的辅助手段，我们提出三维US可以为目标识别和针插入的实时监测提供更完整的成像信息，以及提供一种快速确认活检成功的方法。
