Stereotactic-guided Vacuum-assisted Breast Biopsy in the Asian Population: What Factors Affect Marker Migration?
VYK To, KM Wong, WS Mak, KM Kwok, CW Wong
Hong Kong J Radiol 2016;19:293-9
DOI: 10.12809/hkjr1615395
Objective: Stereotactic-guided vacuum-assisted biopsy (VAB) can be performed in small breast masses, distortions, and microcalcifications. A metallic marker is deployed at the corresponding biopsy site to facilitate localisation if additional surgery is required. There is currently limited literature on the accuracy of marker placement in Asian breasts that tend to be smaller and denser than those in Caucasians. The objective of this study was to evaluate the factors that may affect marker migration in stereotactic VAB at a regional hospital in Hong Kong.
Methods: From January 2010 to June 2015, all stereotactic VAB performed in the screening population at Kwong Wah Hospital were reviewed through the Hologic Selenia workstations and electronic patient records. Consensus between the local breast surgeons and radiologists defined marker migration of <1 cm as insignificant displacement. Marker migration of >1 cm could affect surgical localisation. Factors including age, indication, Breast Imaging–Reporting and Data System (BIRADS) category, needle approach, breast density, breast compression thickness, depth of the lesion, number of biopsy cuttings, complications, and duration of the procedure were recorded. The distance of marker migration from the biopsy site in cranio-caudal and medial-lateral oblique views was measured.
Results: A total of 154 Asian patients underwent stereotactic VAB during the study period. One patient was excluded due to technical failure during deployment of the marker. Of the remaining 153 patients, there was migration of 45 (29.4%) markers, of which 19 (12.4%) were <1 cm, 16 (10.5%) 1-3 cm, 7 (4.6%) 3-5 cm, and 3 (2.0%) >5 cm. Factors including older age, thicker breasts, greater number of biopsy cuttings, and longer duration of the procedure showed statistical significance in affecting marker migration (p < 0.05).
Conclusion: This study identified four factors that could influence marker migration, namely age, breast compression thickness, number of biopsy cuttings, and duration of procedure. Awareness of these factors during the planning of the procedure could potentially decrease the effect of marker migration and thus enable more accurate surgical localisation.
Authors’ affiliation:
Department of Diagnostic and Interventional Radiology, Kwong Wah Hospital, Yaumatei, Hong Kong
中文摘要
亞洲人口的立體定向引導真空輔助乳腺活檢：哪些因素影響標記遷移位？
杜婉筠、黃嘉敏、麥詠詩、郭勁明、黃鎮威
目的：立體定向引導真空輔助活檢（VAB）可以用於治療小乳房腫塊、變畸形和微鈣化的情況下進行。如還需進行額外手術，會在相應的活檢部位部署植入金屬標記以便定位。亞洲婦女的乳房一般比外國人小，乳房組織的密度也較高，放置關於標記物的植入準確性的現存文獻較少。所以本研究的目的是評估香港一所分區醫院內立體定向VAB中可能影響標記遷移移位的因素。
方法：通過Hologic Selenia工作站和病人電子病歷回顧研究2010年1月至2015年6月期間在廣華醫院接受立體定向VAB的患者。乳房外科醫生和放射科醫生一致認為將少於1 cm的標記移位定為非顯著位移。標記移位多於1 cm則可能影響手術定位。記錄影響因素包括年齡、適應症、乳房成像報告和數據系統（BIRAD）分級、針法、乳房密度、乳房壓縮厚度、病變深度、活檢切口數、併發症和操作持續時間。記錄標記位移於頭尾位和內外斜位。
結果：研究期間共有154名亞洲患者接受立體定向VAB。其中1例因標記植入過程中出現故障而被排除出本研究。餘下153例中，45例（29.4%）出現標記物移位，當中19例（12.4%）移位少於1 cm，16例（10.5%）移位1-3 cm，7例（4.6%）移位3-5 cm，3例（2.0%）移位大於5 cm。年齡較大、乳房較厚、活檢切口數量較多和操作時間較長與標記物移位有統計學顯著的相關性（p<0.05）。
結論：這項研究確定了可能影響標記遷移的四項因素，即年齡、乳房壓縮厚度、活檢切割的數量和操作的持續時間。如在規劃操作過程中意識到這些因素則可能減少標記物遷移的影響，從而能夠進行更精確的定位。