Vacuum biopsy
The vacuum biopsy is a procedure for obtaining a tissue sample from suspicious areas of the body for the purpose of a fine tissue (histological) examination. A fenestrated hollow needle is inserted into the tissue to be examined. The tissue is drawn into the interior of the needle by means of vacuum suction, where it is then separated and pulled out. The vacuum biopsy is mostly used on the female breast and prostate .
The stereotactically assisted vacuum biopsy of the female breast
| OPS codes | |
|---|---|
| Vacuum biopsy d. Mom without clip marking | 1-494.31 |
| Vacuum biopsy d. Mamma with clip marking | 1-494.32 |
| Mammography more than two projections | 3-100.2 |
| Specimen radiography | 3-100.3 |
history
The stereotactically assisted vacuum biopsy of the breast was first described by Burbank and Parker in 1996 and used in the USA. The method was first used in Europe in 1997 by Heywang-Köbrunner at the University of Halle and has been increasingly popular ever since.
Indication for examination
The indication for a vacuum biopsy is based on the BI-RADS criteria ( Breast Imaging Reporting and Data System ) of the American College of Radiology based on a mammography in two levels.
- The lesions classified as likely benign ( BI-RADS II and BI-RADS III ) are generally not examined with tissue, unless the patient has a corresponding risk profile, an increased fear of malignant tumors (carcinophobia), or there is an incongruence of clinical and radiological findings.
- Findings that are classified as BI-RADS IV (probably malignant) must be histologically confirmed before an operation.
- Findings classified as BI-RADS V (with a high probability of malignancy) should be biopsied for surgical planning.
- Frustrating sample gains with other biopsy methods should definitely be clarified with the vacuum biopsy.
- Microcalcifications and findings that cannot be clarified with other biopsy methods should preferably be examined. (Guideline, p. 25)
Contraindications
Contraindications for performing a vacuum biopsy are:
- insufficient blood clotting
- the patient cannot be examined in the prone position
- Finding is near the nipple or skin
- weak condensation on the mammography (the digital stereotaxic system has a poorer resolution than the mammography, findings may not be targetable in this way)
Vacuum biopsy technique
Under local anesthesia , the patient is examined in the prone position on the Fischer table , with the breast in question hanging freely down through a gap in the table and being compressed in the desired plane perpendicular to the chest wall .
The direction of compression and puncture is chosen so that the change is achieved in the shortest possible way; on the other hand, the later operative procedure must not be disturbed. The change in the small field of the stereotaxic table is then set and displayed with a straight image (parallel to the direction of compression = 0 °) as well as an image tilted to the left and one to the right (+ 15 °; −15 °).
The exact depth of the lesion can be determined trigonometrically from these images with the aid of the rotated images . The angle and depth of the puncture are calculated so that the window of the 11-G hollow needle (corresponds to 2.95 mm) is placed exactly on the lesion. After making a skin incision , the biopsy needle is advanced to the calculated coordinates on the lesion. The correct position of the needle on the findings is checked by digital stereotactic target images . Then the biopsy needle is pushed into the lesion in such a way that the lesion is drilled through and lies at the level of the removal window. The biopsy needle has two lumens, on each of which a vacuum can be generated independently of one another.
In the first step, the biopsy window is opened and a vacuum suction on the window of the needle transports the tissue directly attached to the inside of the needle, where it is cut off by a rotating knife in the second step. Now the suction in the vacuum area 1 is switched off, then in the third step the biopsate that has been cut off is transported to the rear end of the needle by further suction in the vacuum area 2 and pulling out the needle core, where it is removed. The needle itself remains in the chest.
After the needle core moves back to the removal window, the next tissue removal can be carried out in the same way. By gradually turning the needle around its own axis (e.g. clockwise), the tissue around the needle at the level of the removal window can be removed from the inside. The removal is repeated for every possible position of the window, until a total of up to 6 cm³ of cylinder-shaped tissue has been removed in up to 24 processes (removal in two rounds at every hour of the clock).
Correct removal is checked at the end of the process by stereotactic target exposures . To determine the correct and possibly complete removal of the targeted focus, after hemostatic compression of the breast and closure of the small skin wound with plaster, a control mammography is carried out in two orthogonal planes and, in the case of microcalcifications, a specimen radiography.
The tissue cylinders are fixed in formalin and embedded in paraffin . Thin (5 µm) sections are made from this with a microtome , stained and assessed under the microscope by a specialist in pathology .
Further procedure depending on the histological result
In the case of benign histology, a mammographic follow-up check according to the standard after 6 months is recommended.
In the case of malignant (e.g. ductal carcinoma in situ = DCIS or invasive carcinoma ) or borderline histology (e.g. lobular carcinoma in situ = lobular carcinoma in situ or atypical ductal hyperplasia = atypical ductal hyperplasia - ADH), a subsequent resection is always carried out of the biopsied area with sufficient safety margin. The biopsied area is usually marked preoperatively. The marking can be done stereotactically , whereby the additional exact documentation of the coordinates can be helpful during a vacuum biopsy. If the removal cavity, which is often the case , can be detected sonographically , the marking can also be performed sonographically. If during a vacuum biopsy of a small focal point in a large breast the entire focal point or micro-lime is removed, there is also the option of clip marking at the end of the vacuum biopsy. The preoperative wire marking can be based on the clip.
Safety of the vacuum biopsy
The vacuum biopsy has an accuracy (sensitivity) of almost 100% and a specificity of almost 100%. No major complications have occurred so far; in some cases, circulatory reactions, bruises up to 5 cm or excessive pain sensation have been observed. It has a better accuracy than the operation for non-palpable findings.
The great advantage of this method is that it does not require general anesthesia, as is the case with surgery, and that there are no visible scars or tissue defects. In addition, the mammograms, which are carried out as a check-up in the following years, are not impaired, as no radiologically relevant scarring occurs.
recommendation
According to current breast cancer guidelines, the stereotactically assisted vacuum biopsy is the method of choice for clarifying suspicious, non-palpable findings in the breast that cannot be clarified by means of a sonographic punch biopsy . (Guideline, p. 25)
Individual evidence
- ↑ German Institute for Medical Documentation and Information: ICD and OPS classification online ( Memento of the original from April 15, 2008 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. Retrieved April 12, 2008
- ↑ a b Dt. Society f. Senology: S3 Guideline on Breast Cancer Accessed: April 12, 2008
literature
- Heywang-Köbrunner, Schreer, Decker and Böcker: Interdisciplinary consensus on the use and technique of vacuum assisted stereotactic breast biopsy . In: European Journal of Radiology , 3 (47): 232-236, September 2003.
- Sylvia Helen Heywang-Köbrunner, Ingrid Schreer: Imaging breast diagnostics . Georg Thieme Verlag Stuttgart - New York, 1996. 2nd edition 2003
- Fred Burbank, Steve H. Parker, and Thomas J. Fogarty: Stereotactic breast biopsy: Improved tissue harvesting with the mammotome . In: The American Surgeon , 62: 738-744, 1996.
- Rotter, Haentschel, Koethe, Goetz, Bornhofen-Poschke, Lebrecht, Koelbl and Heywang-Koebrunner: Evaluation of mammographic and clinical follow-up after 755 stereotactic vacuum-assisted breast biopsies . In: The American Journal of Surgery , 2 (186): 134-142, August 2003.
- Nico Vondung: Influence of stereotactic vacuum biopsy versus primary surgery on the further procedure in patients with suspected breast cancer . Dissertation, University of Halle-Wittenberg 2008 ( dissertation online ).
