Stereotactically guided breast biopsy: a review

The aims of this review are to compare and contrast the available stereotactic equipment, and to describe the variety of needle types used and their affect on pathological results and subsequent patient management. Initial stereotactic devices were “added-on” to analogue mammography units and have been replaced by prone or ducubitus equipment using digital image acquisition. Biopsies use either 14-G core biopsy (CB) needles or vacuum-assisted biopsies (VAB). Vacuum-assisted biopsy systems consistently out-perform 14-G CB with reduced need for diagnostic or multi-treatment surgery. The false-negative rate is 8% for 14-G CB compared with 0.7% for VAB. There is a risk of underestimating the disease present for lesions of uncertain malignant potential (Cat B3) and suspicious of malignancy (Cat B4) results with 25% of patients with a B3 biopsy found to have cancer at subsequent surgery and 66% of those with a B4 biopsy. A CB diagnosis of in situ malignancy is upgraded to invasive disease at surgery in 15-36% of patients undergoing CB and of the order of 10% with VAB. A high degree of diagnostic accuracy and hence safe patient care can only be achieved by meticulous attention to technique and multi-disciplinary cooperation

Quantitative breast MRI: 2D histogram analysis of diffusion tensor parameters in normal tissue

OBJECT: Diffusion tensor imaging (DTI) of the breast may provide a powerful new approach for the detection of intraductal processes. The aim of this investigation was to characterize the relation between diffusion tensor parameters [fractional anisotropy (FA), mean diffusivity (MD)] in normal breast tissue to obtain information on the microenvironment of the diffusing water molecules and to provide a systematic approach for DTI analysis. MATERIALS AND METHODS: Seven female, healthy volunteers underwent prospective double-spin-echo prepared echo-planar diffusion-weighted sequence (TR/TE 8,250 ms/74 ms, b values 0 and 500 s/mm (2), six encoding directions, 12 averages, 35 slices) in 4 consecutive weeks (3.0 T). Quantitative maps of diffusion tensor parameters were computed offline with custom routines. The interdependence of MD and FA in different voxels was analysed by linear and exponential regression. RESULTS: All MD and FA maps were of excellent quality. A consistent pattern was observed in that lower fractional anisotropy values were more likely associated with higher mean diffusivity values. The dependence exhibited an exponential behavior with a correlation coefficient R = 0.60 (R linear = 0.57). CONCLUSION: The likelihood with which FA and MD values are observed in a voxel within normal breast tissue is characterized by a specific pattern, which can be described by an exponential model. Moreover, we could show that the proposed technique does not depend on the menstrual cycle