Stereotactic-guided Vacuum-assisted Breast Biopsy in the Asian Population: What Factors Affect Marker Migration?

Abstract

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 mediallateral 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.

Women’s Imaging and Oncology

“…Alternatively, stereotactic-guided vacuumassisted breast biopsy can definitely enable a larger volume of tissue to be obtained although migration can occur of the marker placed at biopsy. To et al4 reported the occurrence of significant marker migration by 1 cm or more in 17% of 153 patients biopsied over a 5-year period that might adversely affect the accuracy of the subsequent surgical localisation procedure. The authors found marker migration was correlated with age, breast compression thickness, number of biopsy cuttings, and duration of the procedure.…”