Three-dimensional targeting: a new three-dimensional ultrasound technique to evaluate needle position during breast biopsy

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 similar to 80 years) showed 77 breast lesions (55 solid lesions, 22 cysts) with a mean diameter of 1.5 (range, 0.3 similar to5.0) cm. Results In 49 women with 55 solid breast lesions, 16 lesions were malignant and 39 lesions benign. In 53 solid breast lesions 188 corp-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.