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Positron Emission Mammography–Guided Breast Biopsy

Center for Advanced Imaging, Department of Radiology, West Virginia University, Morgantown, West Virginia; and Detector Group, Jefferson Laboratory, Newport News, Virginia

Positron emission mammography (PEM) is a technique to obtain planar images of the breast for detection of potentially cancerous, radiotracer-avid tumors. To increase the diagnostic accuracy of this method, use of minimally invasive methods (e.g., core biopsy) may be desirable for obtaining tissue samples from lesions detected with PEM. The purpose of this study was to test the capabilities of a novel method for performing PEM-guided stereotactic breast biopsies. Methods: The PEM system consisted of 2 square (10 x 10 cm) arrays of discrete scintillator crystals. The detectors were mounted on a stereotactic biopsy table. The stereotactic technique used 2 PEM images acquired at ±15° and a new trigonometric algorithm. The accuracy and precision of the guidance method was tested by placement of small point sources of ¹⁸F at known locations within the field of view of the imager. The calculated positions of the sources were compared with the known locations. In addition, simulated stereotactic biopsies of a breast phantom consisting of a 10-mm-diameter gelatin sphere containing a concentration of ¹⁸F-FDG consistent with that reported for breast cancer were performed. The simulated lesion was embedded in a 4-cm-thick slab of gelatin containing a commonly reported concentration of FDG, simulating a compressed breast (target-to-background ratio, approximately 8.5:1). An anthropomorphic torso phantom was used to simulate tracer uptake in the organs of a patient 1 h after a 370-MBq injection of FDG. Five trials of the biopsy procedure were performed to assess repeatability. Finally, a method for verifying needle positioning was tested. Results: The positions of the point sources were successfully calculated to within 0.6 mm of their true positions with a mean error of ±0.4 mm. The biopsy procedures, including the method for verification of needle position, were successful in all 5 trials in acquiring samples from the simulated lesions. Conclusion: The success of this new technique shows its potential for guiding the biopsy of breast lesions optimally detected with PEM.

Key Words: breast biopsy • positron emission mammography • radionuclide guidance