Division of Diagnostic Imaging, Department of Breast Imaging, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe, Unit 1350, Houston, TX, 77030, USA.
, Radiology Partners Houston, 902 Frostwood Drive #184, Houston, TX, 77024, USA.
Eur Radiol. 2023 Sep;33(9):6189-6203. doi: 10.1007/s00330-023-09581-5. Epub 2023 Apr 12.
Compare prone and upright, stereotactic, and tomosynthesis-guided vacuum-assisted breast biopsies (prone DM-VABB, prone DBT-VABB, upright DM-VABB, and upright DBT-VABB) in a community-practice setting and review outcomes of ultrasound-occult architectural distortions (AD).
Consecutive biopsies performed at two community-based breast centers from 2016 to 2019 were retrospectively reviewed. Technical details of each procedure and patient outcomes were recorded. Separate analyses were performed for ultrasound-occult ADs. Two sample t-tests and Fisher's exact test facilitated comparisons.
A total of 1133 patients underwent 369 prone DM-VABB, 324 prone DBT-VABB, 437 upright DM-VABB, and 123 upright DBT-VABB with 99.2%, 100%, 99.3%, and 99.2% success, respectively (p-values > 0.25). Mean lesion targeting times were greater for prone biopsy (minutes: 6.94 prone DM-VABB, 8.54 prone DBT-VABB, 5.52 upright DM-VABB, and 5.51 upright DBT-VABB; p-values < 0.001), yielding longer total prone procedure times for prone biopsy (p < 0.001). Compared to DM-VABB, DBT-VABB used fewer exposures (p < 0.001) and more commonly targeted AD, asymmetries, or masses (p < 0.001). Malignancy rates were similar between procedures: prone DM-VABB 22.4%, prone DBT-VABB 21.9%, upright DM-VABB 22.8%, and upright DBT-VABB 17.2% (p-values > 0.19). One hundred forty of the 1133 patients underwent 145 biopsies for ultrasound-occult AD (143 DBT-VABB and 2 DM-VABB). Biopsy yielded 27 malignancies and 47 high-risk lesions (74 of 145, 51%). Malignancy rate was 20.7% after surgical upgrade of one benign-discordant and two high-risk lesions.
All biopsy procedure types were extremely successful. The 20.7% malignancy rate for ultrasound-occult AD confirms a management recommendation for tissue diagnosis. Upright biopsy was faster than prone biopsy, and DBT-VABB used fewer exposures than DM-VABB.
Our results highlight important differences between prone DM-VABB, prone DBT-VABB, upright DM-VABB, and upright DBT-VABB. Moreover, the high likelihood of malignancy for ultrasound-occult AD will provide confidence in recommending tissue diagnosis in lieu of observation or clinical follow-up.
• Upright and prone stereotactic and tomosynthesis-guided breast biopsies were safe and effective in the community-practice setting. • The malignancy rate for ultrasound-occult architectural distortion of 20.7% confirms the management recommendation for biopsy. • Upright procedures were faster than prone procedures, and tomosynthesis-guided biopsy used fewer exposures than stereotactic biopsy.
比较在社区实践环境下俯卧位和仰卧位、立体定向和断层合成引导下的真空辅助乳腺活检（俯卧位 DM-VABB、俯卧位 DBT-VABB、仰卧位 DM-VABB 和仰卧位 DBT-VABB），并回顾超声隐匿性结构扭曲（AD）的活检结果。
回顾性分析 2016 年至 2019 年在两个社区乳腺中心进行的连续活检。记录了每种手术的技术细节和患者的结果。对超声隐匿性 AD 进行了单独的分析。使用双样本 t 检验和 Fisher 确切检验进行比较。
共有 1133 例患者接受了 369 例俯卧位 DM-VABB、324 例俯卧位 DBT-VABB、437 例仰卧位 DM-VABB 和 123 例仰卧位 DBT-VABB，成功率分别为 99.2%、100%、99.3%和 99.2%（p 值均>0.25）。俯卧位活检的病变定位时间较长（分钟：俯卧位 DM-VABB 为 6.94 分钟、俯卧位 DBT-VABB 为 8.54 分钟、仰卧位 DM-VABB 为 5.52 分钟、仰卧位 DBT-VABB 为 5.51 分钟；p 值均<0.001），导致俯卧位活检的总时间较长（p<0.001）。与 DM-VABB 相比，DBT-VABB 采用的曝光次数更少（p<0.001），更常见地针对 AD、不对称或肿块进行活检（p<0.001）。手术间的恶性肿瘤检出率相似：俯卧位 DM-VABB 为 22.4%、俯卧位 DBT-VABB 为 21.9%、仰卧位 DM-VABB 为 22.8%和仰卧位 DBT-VABB 为 17.2%（p 值均>0.19）。1133 例患者中有 145 例接受了超声隐匿性 AD 的活检（143 例 DBT-VABB 和 2 例 DM-VABB）。活检检出 27 例恶性肿瘤和 47 例高危病变（145 例中的 74 例，51%）。1 例良性不匹配病变和 2 例高危病变经手术升级后，恶性肿瘤检出率为 20.7%。
所有活检手术类型都非常成功。超声隐匿性 AD 的 20.7%恶性肿瘤检出率证实了组织诊断的管理建议。仰卧位活检比俯卧位活检更快，DBT-VABB 比 DM-VABB 采用的曝光次数更少。
我们的结果强调了俯卧位 DM-VABB、俯卧位 DBT-VABB、仰卧位 DM-VABB 和仰卧位 DBT-VABB 之间的重要差异。此外，超声隐匿性 AD 的高度恶性可能有助于推荐进行组织诊断，而不是观察或临床随访。
• 社区实践环境下的俯卧位和仰卧位、立体定向和断层合成引导下的乳腺活检是安全有效的。
• 超声隐匿性结构扭曲的恶性肿瘤检出率为 20.7%，证实了活检的管理建议。
• 仰卧位手术比俯卧位手术更快，断层合成引导活检比立体定向活检采用的曝光次数更少。
