R. Novak: Position-controlled needle aspiration biopsy at mammography
Fortschr. Rontgenstr. 131, 6
659
Position-controlled needle aspiration biopsy at mammography By R. Novak 3 Figures
Gezielte Aspiration sbiopsie in der
Mammographie Ein Instrument für die gezielte Punktion und Aspirationsbiopsie von Mammatumoren wurde entwickelt. Dadurch können blinde Punktionen verhuret werden.
Departnienr of Radiology, Iiikarmottagi-iingen SkirhoImeo, Sweden
A device has been developed which makes possible position control in breast aspiration biopsies which avoids blind punctures in case of nonpalpable breast tumors.
For the microscopic verification of mammography results, needle aspiration biopsy is often used. In order to obtain representative material from a tumor which is difficult or
cone can he removed easily before the puncture so as to provide accessibility for preforming the needle aspiration
impossible to palpate, a puncture technique of great exactitude is essential. Equipment for stich puncture has been described previously (1, 2).
The attachments consist of a compression plate for biopsy and a carbon fiber plate (Fig. 1). The standard equipment compression plate may easily he exchanged for one that is suitable for
Mühlow has described an instrument consisting of a perforated compression plate of plexiglass. The puncture is carried out trough an aperture located over the desired puncture point.
biopsy.
The quality of the mammography, however, is impaired, partly due to the absorption property of the plexiglass, and partly duc to scatter. This scatter affects the image quality, even within the aperture, where there is no plexiglass. Microcalcifications and small lesions are difficult to identify. The puncture posi-
tions are limited to the positions of the preformed holes. Bolmgren, Jacobson and Nordenström have developed a stereotaxic device which offers considerable precision, hut is costly, and at the present time is not available for general use. The increasing number of breast examinations makes neces-
sary a simpler and less expensive alternative. Now a new apparatus has been developed for this purpose in collaboration with Siemens-Elema, of Stockholm.
Technical description The mammography apparatus, the Mammomat-S, has been modified with a addition which makes it possible to determine the position of a pathologic change in one plane for biopsy purposes. The standard radiographic cone has been modified to a two-piece cone. The upper section of the cone is equipped with an optic system consisting of two light indicators. These can he adjusted to the
desired coordinates in order to determine the puncture point by means of intersecting light beams. The lower section of the 0340-1618/79
1232-0659 $ 03.00 © 1979
Fig. 1
The thin carbon fiber plate on the object table. The vacuum cassette can be exchanged without disturbing the compression.
Georg Thieme Publishers
This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
Fortschr. Rotgenstr. 131, 6 (1979) 659--661
660
Fortschr. Röntgensrr. 131, 6
R. Novak: Position-controlled needle aspiration biopsy at mammography
compression plate. An ordinary opening in a flat plate cannot prevent this from occurring. The use of a plate not equipped with a frame would result in the breast bulging through the aperture and would diminish the compression. The thickness of the frame is so designed that other parts of the breast are in contact with the plate. Thus the contact between the plate and the breast assures a stable fixation at the desired position. A thin carbon fiber plate with a very low absorption coefficient is placed on the object table. Between this plate and the table there is a slit approximately 3 mm wide for the vacuum cassette. Thus it is possible to exchange the cassette easily without disturbing the compression (Fig. 1). Fig. 2
Determining the position of the tumor for biopsy.
The needle aspiration biopsy is performed in the following manner: With the use of ordinary mammography images, the projection for the puncture is determined. The original compression plate is exchanged for the biopsy plate. The vacuum cassette is placed on the object table and over it the carbon
fiber plate. The breast is positioned in such a way that the lesion is located within the area of the aperture. The breast is compressed, the exposure is made, and the vacuum cassette is removed without disturbing the compression. The puncture point is determined on the developed film with the aid of the coordinate system (Fig. 2). The lower section of the radiographic cone is removed, and the adjustable light indicators are set by means of the letter and figure combination derived from
the radiograph. The cross formed by the intersecting light beams indicates the puncture point (Fig. 3). The breast is cleansed with a suitable disinfectant agent and the biopsy is performed.
This method offers position control of a lesion in one plane. The firm compression of the breast together with a minimum
of scatter guarantees high image quality. (The scatter
is
minimized since no plastic plate covers the biopsy site). This design satisfies hygienic demands regarding disinfection of the skin. Contamination of the plate with blood can be avoided.
Discussion In our biopsy technique the needle is moved up and down during the continuous aspiration. This offers excellent prospects of obtaining samples form the various depths, and the lesions identified by mammography are represented in the samples. The cytologist, who always participates in the biopsy, Fig. 3
The intersection of the light cross marks the puncture point.
biopsy. In this plate is a 65 x 40 mm rectangular aperture. Along both the length and breadth of the aperture are strips engraved with figures and letters. These figures and letters appear on the exposed film and make it possible to determine the coordinates for the position of the lesion (Fig. 2). On the
under side of the window ist a 1,5 cm thick rounded frame,
is able to ensure that the material is representative. In the choice of the most suitable projection, consideration is always given to the fact that the puncture is done at the site which lies nearest the lesion. It is possible to have a rather good knowledge of a reasonable depth for the biopsy when choosing this puncture site. Example: In the cranio-caudal projection a tumor is situated just lateral to the midline of the breast. In the lateral projection it is situated cranially and is thus located in the lateral upper quadrant. If the breast is compressed from the sides to a thickness of approximately 4 cm, it is readily understood that the tumor could be situated approximately 2 cm beneath the surface of the skin.
which produces a stronger compression and stretches the skin
of the particular area for which the biopsy is planned. This frame has an important function. It presses into the breast and
prevents the breast from bulging up over the surface of the
A rough approximation of the depth is possible if the degree of compression is also considered. The breast can, in general, be compressed to a thickness of 3 to 5 cm. The actual depth of the
This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
Method
Schaukasten
Fortschr. Röntgenstr. 131,6
661
pathological change is not so critical, especially when a biopsy method is used in which the instrument is drawn up and down with a retained vacuum in a predetermined position. At the present time no methods exist which make it possible to control the position of the needle in two perpendicular planes during compression. Experience has indicated, however, that the precision of this present method is satisfactory. The sim-
This device may also be used to indicate small tumors before operation. This indication is possible only in one plane.
plicity of the method described here and the low cost of the attachments make it possible for more radiology departments to perform position-controlled biopsies. At present the majoruy of mammary biopsies of nonpalpable tumors are performed
needle biopsy of the breast at mammography. Amer. J. Roentgenol. 121 (1974) 843-845
Mdhlow, A.: A device for precision
Bolmgren, j., B., Jacobson, B. Nor-
denstrom: Stereotaxic Instru nient for needle biopsy of the mamma. Amer. J. Roenrgenol. 129 (1977) 121-125
Dr. R. Novak Department of Radiology 1.akarmottagningen Storholmsgatan 19 12748 Skärholmen Sweden
This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
more or less blindly.
Literature
Fortschr. Rontgenstr. 131, 6
659
Position-controlled needle aspiration biopsy at mammography By R. Novak 3 Figures
Gezielte Aspiration sbiopsie in der
Mammographie Ein Instrument für die gezielte Punktion und Aspirationsbiopsie von Mammatumoren wurde entwickelt. Dadurch können blinde Punktionen verhuret werden.
Departnienr of Radiology, Iiikarmottagi-iingen SkirhoImeo, Sweden
A device has been developed which makes possible position control in breast aspiration biopsies which avoids blind punctures in case of nonpalpable breast tumors.
For the microscopic verification of mammography results, needle aspiration biopsy is often used. In order to obtain representative material from a tumor which is difficult or
cone can he removed easily before the puncture so as to provide accessibility for preforming the needle aspiration
impossible to palpate, a puncture technique of great exactitude is essential. Equipment for stich puncture has been described previously (1, 2).
The attachments consist of a compression plate for biopsy and a carbon fiber plate (Fig. 1). The standard equipment compression plate may easily he exchanged for one that is suitable for
Mühlow has described an instrument consisting of a perforated compression plate of plexiglass. The puncture is carried out trough an aperture located over the desired puncture point.
biopsy.
The quality of the mammography, however, is impaired, partly due to the absorption property of the plexiglass, and partly duc to scatter. This scatter affects the image quality, even within the aperture, where there is no plexiglass. Microcalcifications and small lesions are difficult to identify. The puncture posi-
tions are limited to the positions of the preformed holes. Bolmgren, Jacobson and Nordenström have developed a stereotaxic device which offers considerable precision, hut is costly, and at the present time is not available for general use. The increasing number of breast examinations makes neces-
sary a simpler and less expensive alternative. Now a new apparatus has been developed for this purpose in collaboration with Siemens-Elema, of Stockholm.
Technical description The mammography apparatus, the Mammomat-S, has been modified with a addition which makes it possible to determine the position of a pathologic change in one plane for biopsy purposes. The standard radiographic cone has been modified to a two-piece cone. The upper section of the cone is equipped with an optic system consisting of two light indicators. These can he adjusted to the
desired coordinates in order to determine the puncture point by means of intersecting light beams. The lower section of the 0340-1618/79
1232-0659 $ 03.00 © 1979
Fig. 1
The thin carbon fiber plate on the object table. The vacuum cassette can be exchanged without disturbing the compression.
Georg Thieme Publishers
This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
Fortschr. Rotgenstr. 131, 6 (1979) 659--661
660
Fortschr. Röntgensrr. 131, 6
R. Novak: Position-controlled needle aspiration biopsy at mammography
compression plate. An ordinary opening in a flat plate cannot prevent this from occurring. The use of a plate not equipped with a frame would result in the breast bulging through the aperture and would diminish the compression. The thickness of the frame is so designed that other parts of the breast are in contact with the plate. Thus the contact between the plate and the breast assures a stable fixation at the desired position. A thin carbon fiber plate with a very low absorption coefficient is placed on the object table. Between this plate and the table there is a slit approximately 3 mm wide for the vacuum cassette. Thus it is possible to exchange the cassette easily without disturbing the compression (Fig. 1). Fig. 2
Determining the position of the tumor for biopsy.
The needle aspiration biopsy is performed in the following manner: With the use of ordinary mammography images, the projection for the puncture is determined. The original compression plate is exchanged for the biopsy plate. The vacuum cassette is placed on the object table and over it the carbon
fiber plate. The breast is positioned in such a way that the lesion is located within the area of the aperture. The breast is compressed, the exposure is made, and the vacuum cassette is removed without disturbing the compression. The puncture point is determined on the developed film with the aid of the coordinate system (Fig. 2). The lower section of the radiographic cone is removed, and the adjustable light indicators are set by means of the letter and figure combination derived from
the radiograph. The cross formed by the intersecting light beams indicates the puncture point (Fig. 3). The breast is cleansed with a suitable disinfectant agent and the biopsy is performed.
This method offers position control of a lesion in one plane. The firm compression of the breast together with a minimum
of scatter guarantees high image quality. (The scatter
is
minimized since no plastic plate covers the biopsy site). This design satisfies hygienic demands regarding disinfection of the skin. Contamination of the plate with blood can be avoided.
Discussion In our biopsy technique the needle is moved up and down during the continuous aspiration. This offers excellent prospects of obtaining samples form the various depths, and the lesions identified by mammography are represented in the samples. The cytologist, who always participates in the biopsy, Fig. 3
The intersection of the light cross marks the puncture point.
biopsy. In this plate is a 65 x 40 mm rectangular aperture. Along both the length and breadth of the aperture are strips engraved with figures and letters. These figures and letters appear on the exposed film and make it possible to determine the coordinates for the position of the lesion (Fig. 2). On the
under side of the window ist a 1,5 cm thick rounded frame,
is able to ensure that the material is representative. In the choice of the most suitable projection, consideration is always given to the fact that the puncture is done at the site which lies nearest the lesion. It is possible to have a rather good knowledge of a reasonable depth for the biopsy when choosing this puncture site. Example: In the cranio-caudal projection a tumor is situated just lateral to the midline of the breast. In the lateral projection it is situated cranially and is thus located in the lateral upper quadrant. If the breast is compressed from the sides to a thickness of approximately 4 cm, it is readily understood that the tumor could be situated approximately 2 cm beneath the surface of the skin.
which produces a stronger compression and stretches the skin
of the particular area for which the biopsy is planned. This frame has an important function. It presses into the breast and
prevents the breast from bulging up over the surface of the
A rough approximation of the depth is possible if the degree of compression is also considered. The breast can, in general, be compressed to a thickness of 3 to 5 cm. The actual depth of the
This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
Method
Schaukasten
Fortschr. Röntgenstr. 131,6
661
pathological change is not so critical, especially when a biopsy method is used in which the instrument is drawn up and down with a retained vacuum in a predetermined position. At the present time no methods exist which make it possible to control the position of the needle in two perpendicular planes during compression. Experience has indicated, however, that the precision of this present method is satisfactory. The sim-
This device may also be used to indicate small tumors before operation. This indication is possible only in one plane.
plicity of the method described here and the low cost of the attachments make it possible for more radiology departments to perform position-controlled biopsies. At present the majoruy of mammary biopsies of nonpalpable tumors are performed
needle biopsy of the breast at mammography. Amer. J. Roentgenol. 121 (1974) 843-845
Mdhlow, A.: A device for precision
Bolmgren, j., B., Jacobson, B. Nor-
denstrom: Stereotaxic Instru nient for needle biopsy of the mamma. Amer. J. Roenrgenol. 129 (1977) 121-125
Dr. R. Novak Department of Radiology 1.akarmottagningen Storholmsgatan 19 12748 Skärholmen Sweden
This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
more or less blindly.
Literature
