Comparison of Upright Digital Breast Tomosynthesis-guided versus Prone Stereotactic Vacuum-assisted Breast Biopsy.

Purpose To compare the performance of upright digital breast tomosynthesis (DBT)-guided vacuum-assisted breast biopsy (VABB) with that of prone stereotactic (PS) VABB. Materials and Methods This retrospective review involved consecutive patients who underwent PS VABB from August 2014 to December 2015 and upright DBT-guided VABB from February 2016 to June 2017. Tissue sampling methods were the same for PS and DBT-guided biopsies. Wilcoxon and Pearson χ2 tests were used to compare the groups. Results During the study period, 439 PS VABBs in 408 patients (mean age, 56.5 years; age range, 32-84 years) and 706 DBT-guided VABBs in 682 patients (mean age, 57.9 years; age range, 23-90 years) were recommended. Technical success was achieved for more lesions with DBT-guided VABB versus PS VABB (99.3% [695 of 700] vs 95.1% [410 of 431], respectively; P < .001). Mean procedure time was shorter with DBT-guided VABB versus PS VABB (12 vs 27 minutes, respectively; P < .001), and fewer exposures were acquired with DBT-guided VABB versus PS VABB (three vs 12, respectively; P < .001). A higher percentage of lesions for which DBT-guided VABB was performed were noncalcified lesions (eg, architectural distortion, asymmetry, and mass) than for PS VABB (29.2% [203 of 695] vs 3.4% [14 of 410], respectively; P < .001). There were no differences in the distribution of histologic results (P = .42). No major complications were observed in either group. Conclusion Upright digital breast tomosynthesis-guided vacuum-assisted breast biopsy has a higher rate of technical success than does prone stereotactic vacuum-assisted biopsy and can be performed in less than half the time and with one-fourth of the exposures. In addition, more architectural distortions and asymmetries are amenable to biopsy with digital breast tomosynthesis-guided vacuum-assisted breast biopsy. © RSNA, 2018.