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A comparison of stereotactic and tomosynthesis-guided localisation of impalpable breast lesions.
J Med Radiat Sci 2019; 66(3):170-176JM

Abstract

INTRODUCTION

Impalpable breast cancers require precise pre-operative lesion localisation to minimise re-excision rates. Conventional techniques include hookwire insertion using stereotactic guidance. Newer techniques include the use of tomosynthesis guidance and the use of iodine-125 seeds. This study compares the accuracy of lesion localisation with hookwire or seed insertion using prone stereotactic or upright tomosynthesis guidance.

METHODS

This registered quality improvement activity did not require formal ethics approval. The post-localisation images for 116 lesions were reviewed. The distance from the lesion or breast biopsy marker to the hookwire or seed was measured on post-insertion mammograms. The relative placement accuracy of hookwire or seed using prone stereotactic or upright tomosynthesis guidance was compared. A lesion to seed or wire distance > 10 mm was considered technically unsatisfactory.

RESULTS

94.8% of the seeds and wires inserted via prone stereotactic guidance were accurately placed, compared with 89.6% of those inserted via upright tomosynthesis. There were twice as many technically unsatisfactory insertions under upright tomosynthesis guidance. The majority of the unsatisfactory insertions using upright tomosynthesis occurred when the lesion was at or below the level of the nipple and the insertion was performed craniocaudally.

CONCLUSION

The degree of accuracy of pre-operative localisation of impalpable breast lesions is significantly higher with the use of prone stereotactic rather than upright tomosynthesis guidance. This was most evident with the placement of I-125 seeds, and in cases where the target lesion was located below the level of the nipple.

Authors+Show Affiliations

Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Perth, Western Australia, Australia. Breast Screen Western Australia, Perth, Western Australia, Australia.Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Perth, Western Australia, Australia.SEA Pty LTD, Perth, Western Australia, Australia.Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Perth, Western Australia, Australia. Medical School, Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Western Australia, Australia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31347295

Citation

Madeley, Carolyn, et al. "A Comparison of Stereotactic and Tomosynthesis-guided Localisation of Impalpable Breast Lesions." Journal of Medical Radiation Sciences, vol. 66, no. 3, 2019, pp. 170-176.
Madeley C, Kessell M, Madeley C, et al. A comparison of stereotactic and tomosynthesis-guided localisation of impalpable breast lesions. J Med Radiat Sci. 2019;66(3):170-176.
Madeley, C., Kessell, M., Madeley, C., & Taylor, D. (2019). A comparison of stereotactic and tomosynthesis-guided localisation of impalpable breast lesions. Journal of Medical Radiation Sciences, 66(3), pp. 170-176. doi:10.1002/jmrs.348.
Madeley C, et al. A Comparison of Stereotactic and Tomosynthesis-guided Localisation of Impalpable Breast Lesions. J Med Radiat Sci. 2019;66(3):170-176. PubMed PMID: 31347295.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A comparison of stereotactic and tomosynthesis-guided localisation of impalpable breast lesions. AU - Madeley,Carolyn, AU - Kessell,Meredith, AU - Madeley,Chris, AU - Taylor,Donna, Y1 - 2019/07/25/ PY - 2018/12/09/received PY - 2019/05/23/revised PY - 2019/06/17/accepted PY - 2019/7/28/pubmed PY - 2019/7/28/medline PY - 2019/7/27/entrez KW - accuracy KW - breast KW - lesion localisation KW - stereotactic KW - tomosynthesis SP - 170 EP - 176 JF - Journal of medical radiation sciences JO - J Med Radiat Sci VL - 66 IS - 3 N2 - INTRODUCTION: Impalpable breast cancers require precise pre-operative lesion localisation to minimise re-excision rates. Conventional techniques include hookwire insertion using stereotactic guidance. Newer techniques include the use of tomosynthesis guidance and the use of iodine-125 seeds. This study compares the accuracy of lesion localisation with hookwire or seed insertion using prone stereotactic or upright tomosynthesis guidance. METHODS: This registered quality improvement activity did not require formal ethics approval. The post-localisation images for 116 lesions were reviewed. The distance from the lesion or breast biopsy marker to the hookwire or seed was measured on post-insertion mammograms. The relative placement accuracy of hookwire or seed using prone stereotactic or upright tomosynthesis guidance was compared. A lesion to seed or wire distance > 10 mm was considered technically unsatisfactory. RESULTS: 94.8% of the seeds and wires inserted via prone stereotactic guidance were accurately placed, compared with 89.6% of those inserted via upright tomosynthesis. There were twice as many technically unsatisfactory insertions under upright tomosynthesis guidance. The majority of the unsatisfactory insertions using upright tomosynthesis occurred when the lesion was at or below the level of the nipple and the insertion was performed craniocaudally. CONCLUSION: The degree of accuracy of pre-operative localisation of impalpable breast lesions is significantly higher with the use of prone stereotactic rather than upright tomosynthesis guidance. This was most evident with the placement of I-125 seeds, and in cases where the target lesion was located below the level of the nipple. SN - 2051-3909 UR - https://www.unboundmedicine.com/medline/citation/31347295/A_comparison_of_stereotactic_and_tomosynthesis-guided_localisation_of_impalpable_breast_lesions DB - PRIME DP - Unbound Medicine ER -
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