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Three-dimensional targeting: a new three-dimensional ultrasound technique to evaluate needle position during breast
C F Weismann1, R Forstner, E Prokop
1Department of Diagnostic Radiology, St. Johanns Hospital, Landeskliniken Salzburg, Muellner Hauptstrasse 48, 5020 Salzburg, Austria.
Objective:
To evaluate the role of three-dimensional (3D) ultrasound (US) following needle breast biopsy under two-dimensional (2D) needle guidance.
Methods:
A total of 188 core-needle biopsies and 24 fine-needle aspiration biopsies were 3D US correlated after typical 'freehand' US needle guidance. All cases were examined with a linear 3D US volume scanner (5-13 MHz, Voluson 530D, Medison-Kretztechnik, Zipf, Austria). After core-needle stroke or localization of fine needle, a 3D US data volume set was acquired and a multiplanar analysis performed. This needle position check in all three planes is called '3D targeting'. 66 women with a mean age of 51 years (range, 27-80 years) showed 77 breast lesions (55 solid lesions, 22 cysts) with a mean diameter of 1.5 (range, 0.3-5.0) cm.
Results:
In 49 women with 55 solid breast lesions, 16 lesions were malignant and 39 lesions benign. In 53 solid breast lesions 188 core-needle biopsies were performed (mean 3.6 biopsies/lesion). After core-needle biopsy 23 lesions (16 malignant, seven benign) were surgically removed. In 22 cases final histology confirmed results of the core-needle specimen. In one case a core-needle specimen of a 5 mm lesion showed atypical lobular hyperplasia. The definitive histology after surgery was invasive lobular carcinoma. Twenty-two cysts and two benign solid lesions were punctured with a fine needle followed by aspiration biopsy. The overall sensitivity of core-needle results in this study was 94% (specificity 100%, accuracy 0.98, positive predictive value 1, negative predictive value 0.97). In 117 core-needle strokes of benign (21) and malignant (12) lesions 3D targeting prospectively revealed 95 lesion hits, Twelve marginal lesion hits and nine out-of-lesion hits. In one case after the initial large core-needle path a 5-mm lesion was disguised by air bubbles, therefore 3D targeting failed during the second biopsy procedure.
Conclusion:
3D US combined with 3D targeting technique is a reliable and objective tool demonstrating exact spatial positioning of core and fine needle during biopsy procedure.