Prone Versus Upright Digital Tomosynthesis-Guided Biopsy

OBJECTIVE. The objective of our study was to compare the performance of digital breast tomosynthesis (DBT)-guided prone and upright breast biopsies. MATERIALS AND METHODS. In this retrospective study, we reviewed all consecutive DBT-guided breast biopsies performed at our institution from May 1, 2018, to July 31, 2019. We recorded patient age, breast density, biopsy indications and technique, number of samples obtained, number of exposures performed, procedure times, percentage of calcifications removed, biopsy complications, histopathologic diagnosis, and radiology-pathology concordance. These characteristics were then compared between biopsy methods using the chi-square test or Wilcoxon rank sum test. RESULTS. There were 282 patients in our study: 215 patients (76.2%) underwent prone DBT-guided biopsy, and 67 (23.8%) underwent upright DBT-guided biopsy. All patients (100%) had technically successfully biopsies. The mean number of exposures for upright biopsies was significantly lower than the mean number of exposures for prone biopsies (p < 0.001). Otherwise, there was no significant difference between the two biopsy methods in the mean number of samples acquired (p = 0.26), mean procedure time (p = 0.67), percentage of calcifications removed (p = 0.31), or biopsy complications (p = 0.56). CONCLUSION. Besides the mean number of exposures acquired, prone and upright DBT-guided biopsies have similar clinical performance. Other factors, such as room utilization and patient comfort, should be considered when deciding between prone and upright DBT-guided biopsies.