ADMIN 2019. 12. 07.
 Mammotome biopsy
글쓴이: 한유  날짜: 2003.03.13. 03:37:08   조회: 1387   글쓴이IP: 61.73.98.241
: This technology involves a biopsy suction apparatus that will remove progressively larger cores of tissue in and around a lesion identified on mammograms. The advantage of this technique over a stereotactic core is that a larger tissue sample can be removed. The disadvantage is that one does not know whether the entire abnormality has been removed.


Other stereotactic biopsy methods: The Mammotome and ABBI are two new instruments for removing stereotactic breast biopsies. One potential disadvantage of fine needle and core biopsy methods for biopsy of abnormalities found by mammography (such as microcalcifications) is that they remove only a small sample of tissue from the abnormality. If the biopsy finds cancer, it can be assumed to be accurate. But, if no cancer is found, there may be some uncertainty as to whether the needle point missed the target. Until recently, an excisional biopsy with wire localization was the only way to remove all or most of a non-palpable (seen on mammography but cannot be felt) area of abnormal tissue containing microcalcifications. During the past few years, two new devices have been invented that can be guided by stereotactic methods and can remove more tissue than a core biopsy. The Mammotome, also known as vacuum-assisted biopsy, uses suction to draw tissue into an opening in the side of a cylinder inserted into the breast tissue. A rotating knife then cuts the tissue samples from the rest of the breast. This method usually removes about twice as much tissue as core biopsies. The ABBI method (short for Advanced Breast Biopsy Instrument) uses a rotating circular knife, and a thin wire heated by electrical current to remove a large cylinder of tissue containing the abnormality. The amount of tissue sampled with the ABBI is usually much greater than with the Mammotome. Both the Mammotome and ABBI instruments have been recently approved by the US Food and Drug Administration (FDA) for use in diagnosis of breast abnormalities. But, breast specialists still disagree about when each of these instruments should be used for diagnosis of non-palpable abnormalities, and whether some should be used at all.


Ultrasound-Guided Breast Biopsy
This procedure is reviewed by a physician with expertise in the area presented and is further reviewed by committees from the American College of Radiology (ACR) and the Radiological Society of North America (RSNA), comprising physicians with expertise in several radiologic areas.

What is Ultrasound-Guided Breast Biopsy?
What are some common uses of the procedure?
How should I prepare for the procedure?
What does the equipment look like?
How does the procedure work?
How is the procedure performed?
What will I experience during the procedure?
Who interprets the results and how do I get them?
What are the benefits vs. risks?
What are the limitations of Ultrasound-Guided Breast Biopsy?












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What is Ultrasound-Guided Breast Biopsy?
Mammography is an excellent way to detect breast abnormalities, but in many cases it is not possible to tell from the mammogram alone whether a growth is benign or cancerous. Ultrasound-guided breast biopsy is a highly accurate way to evaluate suspicious masses within the breast, whether or not they can be felt on breast self-examination or clinical examination. The procedure prevents the need to remove tissue surgically, and also eliminates the radiation exposure that comes from using x-rays to locate a mass. After placing an ultrasound probe over the site of the breast lump and using local anesthesia, the radiologist guides a biopsy needle directly into the mass. Tissue specimens are then taken using either an automatic spring-loaded device or a new instrument, the Mammotome®.

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What are some common uses of the procedure?
Most often ultrasound is used to guide breast biopsy when performed with either a large hollow needle (automated core breast biopsy) or a new vacuum-powered instrument called the Mammotome. When it is necessary to do an open surgical biopsy, a guide wire first is passed directly into the mass, and this procedure also may be guided by ultrasound. In general, ultrasound is well-suited to evaluate small, dense breasts, while x-ray guidance is more successful for breasts that are larger and have more fatty tissue.

Ultrasound-guided biopsy may be helpful in a woman who has a strong family history of breast cancer, or if the appearance of the mass is relatively suspicious. Other reasons for the procedure include areas of distorted breast tissue; a nodule with irregular borders; or a mass that has recurred after previous breast surgery. Finally, either the patient or physician may strongly prefer a through-the-skin procedure to open surgical biopsy.

Ultrasound-guided biopsy is most useful when there are suspicious changes on the mammogram that can also be seen on an ultrasound exam, but no abnormality can be felt on breast self-examination or clinical examination by your primary care physician.

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How should I prepare for the procedure?
Although ultrasound-guided breast biopsy is minimally invasive, there is a risk of bleeding whenever the skin is penetrated. For this reason, if you are taking aspirin or a blood thinner, your physician may advise you to stop three days before the procedure. A breast biopsy always raises concern about cancer. You may want to have a relative or friend present to lend support, and also to drive you home afterwards.

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What does the equipment look like?
Before the radiologist arrives to do the biopsy, staff will set up a sterile tray containing syringes pre-filled with local anesthetic, sponges, forceps with which to handle the specimen, and a specimen cup. If a Mammotome biopsy is planned, there will be a jointed arm attached to the examination table to hold the instrument firmly in place. The radiologist holds an ultrasound device in one hand while using the other to guide the needle into the lesion.

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How does the procedure work?
Ultrasonography uses sound waves at very high frequency to image internal structures including those deep within the body. Either pulsed or continuous sound waves are directed at the area of interest using a hand-held device called a transducer. It also receives echoes of the sound waves whose pattern reflects the outlines of the mass. The transducer changes electrical signals into ultrasound waves, and converts the reflected sound waves back to electrical energy. Unlike radiological procedures, the ultrasound method requires no exposure to x-rays.

When ultrasound is chosen to guide a breast biopsy, one of the biopsy instruments used is the Mammotome. Nodules less than about an inch in size can be totally removed using this equipment. The Mammotome uses vacuum pressure to pull tissue into a needle probe and removes it without having to withdraw the probe after each sampling - as is necessary when the core needle method is used. Biopsies are obtained in an orderly manner by rotating the probe, ensuring that the entire region of interest will be sampled.

The core needle method is used most commonly because it is least expensive and easy to perform. An inner needle with a trough extending from it at one end is covered by a sheath and attached to a spring-loaded mechanism. When the mechanism is fired, the needle shoots forward, filling the trough with breast tissue, and the outer sheath instantly moves forward to cut the tissue and keep it in the trough. It takes only a fraction of a second to obtain a sample, and for each sample it is necessary to withdraw the needle to collect the tissue.

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How is the procedure performed?
With the patient lying on her back or turned slightly to the side, the ultrasound probe is used to locate the lesion. Enough local anesthesia is injected to be sure that she will feel no discomfort during the procedure. Ultrasound also is used to guide the injection of anesthetic along the route to the lesion and about the mass. A very small nick is made in the skin at the site where the biopsy needle is to be inserted. The radiologist, constantly monitoring the lesion site with the ultrasound probe, guides a hollow core biopsy needle or the Mammotome needle directly into the mass and obtains specimens. Usually five to 10 samples are taken using the core biopsy method, and about 15 when using the Mammotome. Frequently the Mammotome will remove the entire mass, a process that can be continuously monitored with the ultrasound probe. In some cases it may be difficult to visualize the needle in the breast tissue, and considerable skill is needed to coordinate movements of the ultrasound transducer with needle insertion.

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What will I experience during the procedure?
You will be awake during your biopsy, and should have little or no discomfort. In some facilities, virtual reality glasses may be plugged into the ultrasound machine so that you are able to watch the progress of the biopsy as it is carried out. Generally the biopsy is completed in less than an hour. It is not necessary to close the tiny skin incision with sutures; a small compression dressing will do. Most patients are able to resume their usual activities later the same day.

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Who interprets the results and how do I get them?
The pathologist will examine the tissue specimens after they are processed. A definite diagnosis will be available within a few days, the main question being whether the breast mass is benign or cancerous. When the final biopsy findings are available, you will have a session with your physician to discuss the results and decide together on the next step. If cancer is diagnosed, you probably will be referred to a tumor specialist or surgeon.

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What are the benefits vs. risks?
Benefits
Ultrasound-guided breast biopsy reliably provides tissue samples that can show whether a breast lump is benign or malignant. When using the Mammotome it often is possible to remove the entire lesion.

Ultrasound-guided core biopsy, using either the core method or the Mammotome, takes much less time that surgical biopsy, causes less tissue damage, and is far less costly.

Compared to x-ray-guided breast biopsy, the ultrasound method is faster and avoids the need for ionizing radiation exposure. With ultrasound, it is possible to follow the motion of the biopsy needle as it takes place.

Ultrasound-guided breast biopsy is able to evaluate lumps under the arm or near the chest wall, which are hard to assess by the x-ray-guided method.

Ultrasound-guided biopsy is somewhat less expensive than the x-ray-guided method.


Risks
When the Mammotome is used for ultrasound-guided breast biopsy, large pieces of tissue are removed and there is a risk of bleeding and formation of a hematoma, a collection of blood at the biopsy site. The risk, however, appears to be less than one percent of patients.

An occasional patient has significant discomfort, which can be readily controlled by non-prescription pain medication.

Infection can occur whenever the skin is penetrated, but the chance of infection requiring antibiotic therapy is less than one in one thousand.

Doing a biopsy of tissue deep in the breast carries a slight risk that the needle will pass through the chest wall, allowing in air that could collapse a lung. This is a rare occurrence.

There is concern that, if cancer is present, multiple passages of a core biopsy needle might break off cancer cells from the mass and cause them to spread, but whether this actually happens is not known. It is not a risk when using the Mammotome.
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What are the limitations of Ultrasound-Guided Breast Biopsy?
Like x-ray-guided breast biopsy, ultrasound-guided biopsy occasionally will miss a lesion or underestimate the extent of disease. If the diagnosis remains uncertain after a technically successful procedure, surgical biopsy will be necessary. The ultrasound-guided method cannot be used unless the mass can be seen on an ultrasound exam. Calcifications within a cancerous nodule are not shown as clearly by this approach as when x-rays are used.

Small lesions may be difficult to target accurately by ultrasound-guided core biopsy.



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