PT  - JOURNAL ARTICLE
AU  - Hugg, James
AU  - Keen, Rochelle
AU  - Beylin, David
AU  - Anashkin, Edward
AU  - Millsap, Eileen
AU  - Moore, Ronald
TI  - Biopsy guided by molecular breast imaging (MBI)
DP  - 2013 May 01
TA  - Journal of Nuclear Medicine
PG  - 482--482
VI  - 54
IP  - supplement 2
4099  - http://jnm.snmjournals.org/content/54/supplement_2/482.short
4100  - http://jnm.snmjournals.org/content/54/supplement_2/482.full
SO  - J Nucl Med2013 May 01; 54
AB  - 482 Objectives Molecular Breast Imaging (MBI) uses planar imaging with single gamma photon emission to visualize breast cancers that are often occult on mammography in the 40-50% of women with radiographically dense breasts. Mayo Clinic has reported successful dense-breast MBI screening trials using only 4-8 mCi of Tc99m-sestamibi (off-label), a low whole-body dose approaching that of screening mammography. Our purpose was to provide MBI-guided biopsy capability for the ~15% of cases when an MBI-detected lesion is occult on ultrasound and mammography. Methods MBI consists of a pair of opposed semiconductor (CZT) gamma photon cameras that mildly compress each breast in standard planar mammographic views. For 3D Cartesian (xyz) lesion targeting we use a third small orthogonal CZT camera. A stereotactic needle guide provides lateral access between the two main cameras for hub-to-hub insertion of the biopsy sampling device parallel to the chest wall. The needle track is verified by imaging a rod source prior to tissue sampling. MBI imaging of the biopsy tissue samples provides verification and guidance for pathology. Results Laboratory testing with a point source and with sponge phantoms containing Tc99m-labeled frozen gelatin lesions demonstrate that MBI is capable of guiding the biopsy sampling needle to within less than 4 mm of the target lesion. The biopsy guidance accessory is capable of targeting and sampling lesions throughout the breast. The setup and MBI-guidance procedure are simple and quick. In ongoing multi-site clinical tests, the trade-off of dose and procedure time is being optimized. Conclusions A simple and effective MBI-guided biopsy accessory has been built and tested and is pending FDA 510(k) clearance. Along with the prior demonstration of low-dose dense-breast MBI screening in pilot studies, the next step toward FDA clearance for adjunctive MBI screening will be multi-center trials. Research Support NIH National Cancer Institute grants R42-CA128407 and R44-CA143716.