Tomosynthesis-directed coaxial core biopsy of tomosynthesis-detected architectural distortion: indications and logistics

As digital breast tomosynthesis has become more widely integrated into clinical practice for both screening and diagnostic evaluation, the need to biopsy suspicious findings only visible on tomosynthesis has increased. Based on multiple reports, the most frequent imaging feature that presents in this way is architectural distortion, which carries a 21%-36% chance of malignancy. Several centres have reported on the accuracy of tomosynthesis-directed needle localization and vacuum assisted biopsy for obtaining a diagnosis for these lesions. A dedicated tomosynthesis-guided biopsy system is commercially available for 1 manufacturer (Affirm Biopsy System, Hologic Inc, Bedford, MA, USA). However, not all facilities have the resources to purchase this equipment and other companies have yet to develop reliable biopsy guidance systems. Without tomosynthesis biopsy capability, breast imagers typically rely on other modalities, such as ultrasound and magnetic resonance imaging, to identify the suspicious area and guide biopsy. However, in rare cases, an imaging correlate for the tomosynthesis-only finding may not exist on sonography or the patient might have a contraindication to magnetic resonance imaging. Therefore, although infrequent, there is a need to be able to provide timely diagnosis to patients with a suspicious imaging finding only seen on tomosynthesis in the absence of a dedicated tomosynthesis-guided biopsy system. (author)