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Stereotactic Histologic Biopsy in Breasts with Implants¹

¹ From the Department of Radiology, Palo Alto Medical Clinic, 795 El Camino Real, Palo Alto, CA 94301. From the 1999 RSNA scientific assembly. Received January 4, 2001; revision requested February 28; revision received May 1; accepted May 22. Partially supported by an educational grant from Biopsys to the Palo Alto Medical Foundation. Address correspondence to R.J.J. (e-mail: jackmanr@pamf.org).

View larger version (75K): [in a new window]   Figure 1a. Biopsy was successful in a 59-year-old woman despite moderate positioning problems. (a) Mediolateral prebiopsy stereotactic mammograms obtained with a "target-on-scout" technique (13) show an indistinct 12-mm mass (arrow) close to a silicone-filled subglandular implant (arrowheads). An electronic square marker is at the center of the mass. There is firm compression of the suboptimally displaced implant but only moderate compression of the adjacent breast tissue. (b) Mediolateral stereotactic mammograms show that the 11-gauge vacuum-assisted biopsy probe has been fired outside the breast and manually inserted to the postfire position. The mass (arrow) has been pushed deeper into the breast, and the electronic square marker is no longer at the center of the mass. To complete the biopsy, the sampling notch (arrowhead) of the probe was pushed farther into the breast to the new depth of the mass and rotated 180° away from the implant and toward the mass. Histopathologic slides (not shown) of 15 tissue samples revealed fat necrosis, inflammation, and fibrosis. Mammograms (not shown) revealed decreased mass size 10 months after biopsy and stability 44 months after biopsy.

View larger version (77K): [in a new window]   Figure 1b. Biopsy was successful in a 59-year-old woman despite moderate positioning problems. (a) Mediolateral prebiopsy stereotactic mammograms obtained with a "target-on-scout" technique (13) show an indistinct 12-mm mass (arrow) close to a silicone-filled subglandular implant (arrowheads). An electronic square marker is at the center of the mass. There is firm compression of the suboptimally displaced implant but only moderate compression of the adjacent breast tissue. (b) Mediolateral stereotactic mammograms show that the 11-gauge vacuum-assisted biopsy probe has been fired outside the breast and manually inserted to the postfire position. The mass (arrow) has been pushed deeper into the breast, and the electronic square marker is no longer at the center of the mass. To complete the biopsy, the sampling notch (arrowhead) of the probe was pushed farther into the breast to the new depth of the mass and rotated 180° away from the implant and toward the mass. Histopathologic slides (not shown) of 15 tissue samples revealed fat necrosis, inflammation, and fibrosis. Mammograms (not shown) revealed decreased mass size 10 months after biopsy and stability 44 months after biopsy.

View larger version (114K): [in a new window]   Figure 2. Mediolateral oblique stereotactic mammograms obtained in a 64-year-old woman with a saline-filled subglandular implant (arrowheads), marked positioning problems, and suboptimally small tissue samples. A specimen radiograph (not shown) was negative. There is firm compression of the suboptimally displaced implant but poor compression of the adjacent breast tissue. A faint 7-mm cluster of amorphous calcifications (arrows) at the tip of the 14-gauge large-core needle and excellent prefire positioning are shown. The calcifications are better seen in both inset images. (Electronic magnification, x6.) Histopathologic slides (not shown) of the 12 suboptimally small tissue samples revealed fibrous tissue with no evident calcifications. Mammograms (not shown) have been stable for 70 months after biopsy. Cursor = orientation marker.

View larger version (157K): [in a new window]   Figure 3a. Mammograms obtained in a 63-year-old woman with a silicone-filled subpectoral implant who developed a large hematoma during biopsy. A negative specimen radiograph (not shown) was obtained. (a) Craniocaudal scout mammogram shows a faint 5-mm cluster of amorphous calcifications (arrow). (b) Craniocaudal 15° stereotactic mammogram acquired after five tissue samples with 11-gauge vacuum-assisted biopsy (when initial specimen radiograph [not shown] was negative), shows a 4-cm hematoma obscuring the calcifications and preventing lesion retargeting. The electronic square marker is at the prebiopsy site of the calcifications. A repeat specimen radiograph (not shown) obtained after 12 tissue samples also was negative, but histopathologic slides (not shown) revealed proliferative fibrocystic changes, with calcifications evident in some ducts. Mammograms (not shown) have been stable for 20 months after biopsy.

View larger version (133K): [in a new window]   Figure 3b. Mammograms obtained in a 63-year-old woman with a silicone-filled subpectoral implant who developed a large hematoma during biopsy. A negative specimen radiograph (not shown) was obtained. (a) Craniocaudal scout mammogram shows a faint 5-mm cluster of amorphous calcifications (arrow). (b) Craniocaudal 15° stereotactic mammogram acquired after five tissue samples with 11-gauge vacuum-assisted biopsy (when initial specimen radiograph [not shown] was negative), shows a 4-cm hematoma obscuring the calcifications and preventing lesion retargeting. The electronic square marker is at the prebiopsy site of the calcifications. A repeat specimen radiograph (not shown) obtained after 12 tissue samples also was negative, but histopathologic slides (not shown) revealed proliferative fibrocystic changes, with calcifications evident in some ducts. Mammograms (not shown) have been stable for 20 months after biopsy.