Surry K J M, Mills G R, Bevan K, Downey D B, Fenster A
Imaging Research Labs, Robarts Research Institute, London, Ontario N6A 5K8, Canada.
Med Phys. 2007 Nov;34(11):4348-58. doi: 10.1118/1.2794175.
Stereotactic X-ray mammography (SM) and ultrasound (US) guidance are both commonly used for breast biopsy. While SM provides three-dimensional (3D) targeting information and US provides real-time guidance, both have limitations. SM is a long and uncomfortable procedure and the US guided procedure is inherently two dimensional (2D), requiring a skilled physician for both safety and accuracy. The authors developed a 3D US-guided biopsy system to be integrated with, and to supplement SM imaging. Their goal is to be able to biopsy a larger percentage of suspicious masses using US, by clarifying ambiguous structures with SM imaging. Features from SM and US guided biopsy were combined, including breast stabilization, a confined needle trajectory, and dual modality imaging. The 3D US guided biopsy system uses a 7.5 MHz breast probe and is mounted on an upright SM machine for preprocedural imaging. Intraprocedural targeting and guidance was achieved with real-time 2D and near real-time 3D US imaging. Postbiopsy 3D US imaging allowed for confirmation that the needle was penetrating the target. The authors evaluated 3D US-guided biopsy accuracy of their system using test phantoms. To use mammographic imaging information, they registered the SM and 3D US coordinate systems. The 3D positions of targets identified in the SM images were determined with a target localization error (TLE) of 0.49 mm. The z component (x-ray tube to image) of the TLE dominated with a TLEz of 0.47 mm. The SM system was then registered to 3D US, with a fiducial registration error (FRE) and target registration error (TRE) of 0.82 and 0.92 mm, respectively. Analysis of the FRE and TRE components showed that these errors were dominated by inaccuracies in the z component with a FREz of 0.76 mm and a TREz of 0.85 mm. A stereotactic mammography and 3D US guided breast biopsy system should include breast compression for stability and safety and dual modality imaging for target localization. The system will provide preprocedural x-ray mammography information in the form of SM imaging along with real-time US imaging for needle guidance to a target. 3D US imaging will also be available for targeting, guidance, and biopsy verification immediately postbiopsy.
立体定向乳腺X线摄影（SM）和超声（US）引导均常用于乳腺活检。虽然SM提供三维（3D）靶向信息，而US提供实时引导，但两者都有局限性。SM是一个漫长且令人不适的过程，且US引导的过程本质上是二维（2D）的，需要技术熟练的医生以确保安全和准确。作者开发了一种3D US引导活检系统，使其与SM成像相结合并对其进行补充。他们的目标是通过SM成像明确模糊结构，从而能够使用US对更大比例的可疑肿块进行活检。结合了SM和US引导活检的特征，包括乳房固定、受限的针道以及双模态成像。3D US引导活检系统使用7.5 MHz的乳腺探头，并安装在立式SM机器上用于术前成像。术中靶向和引导通过实时2D和近实时3D US成像实现。活检后3D US成像可确认针是否穿透目标。作者使用测试体模评估了他们系统的3D US引导活检准确性。为了使用乳腺X线摄影成像信息，他们对SM和3D US坐标系进行了配准。在SM图像中识别出的目标的3D位置通过目标定位误差（TLE）为0.49 mm来确定。TLE的z分量（X射线管到图像）占主导，TLEz为0.47 mm。然后将SM系统与3D US进行配准，基准配准误差（FRE）和目标配准误差（TRE）分别为0.82和(0.92) mm。对FRE和TRE分量的分析表明，这些误差主要由z分量的不准确性主导，FREz为0.76 mm，TREz为0.85 mm。立体定向乳腺X线摄影和3D US引导乳腺活检系统应包括用于稳定性和安全性的乳房压迫以及用于目标定位的双模态成像。该系统将以SM成像的形式提供术前乳腺X线摄影信息，以及用于针引导至目标的实时US成像。活检后立即也可使用3D US成像进行靶向、引导和活检验证。
