Digital breast Tomosynthesis vacuum assisted biopsy for Tomosynthesis-detected Sonographically occult lesions


      • DBT VAB is fast, averaging 15 min, and accurate for targeting DBT-detected lesions.
      • DBT VAB yielded actionable pathologies in a majority of cases, requiring surgical attention.
      • DBT VAB should be performed if DBT lesions are not well seen on 2D mammography or US.



      To assess the utility and pathological results from DBT VAB for lesions occult on 2D mammography and breast ultrasound (US).

      Materials and methods

      A retrospective review of 1116 consecutive stereotactic biopsies was performed over 27 months. DBT VAB was performed for 38 non-calcified lesions which were solely detected using DBT. Imaging findings and pathology results were reviewed.


      Pathologic findings were malignant in 8 of 38 lesions [masses (5) and distortion (3)]. High-risk findings found in 14 lesions.


      DBT VAB is easily performed and the majority of cases yield actionable pathologies. Therefore, perform DBT VAB primarily when available.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Clinical Imaging
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Skaane P.
        • Bandos A.I.
        • Gullien R.
        • et al.
        Comparison of digital mammography alone and digital mammography plus tomosynthesis in a population-based screening program.
        Radiology. 2013; 267: 47-56
        • Rose S.L.
        • Tidwell A.L.
        • Bujnoch L.J.
        • Lushwaha A.C.
        • Nordmann A.S.
        • Sexton Jr., R.
        Implementation of breast tomosynthesis in a routine screening practice: an observational study.
        Am J Roentgenol. 2013; 200: 1401-1408
        • Durand M.A.
        • Wang S.
        • Hooley R.J.
        • Raghu M.
        • Philpotts L.E.
        Tomosynthesis-detected architectural distortion: management algorithm with radiologic-pathologic correlation.
        Radiographics. 2016; 36: 311-321
        • Freer P.E.
        • Niell B.
        • Rafferty E.A.
        Preoperative Tomosynthesis-guided needle localization of Mammographically and Sonographically occult breast lesions.
        Radiology. 2015; 275: 377-383
        • Ray K.M.
        • Turner E.
        • Sickles E.A.
        • Joe B.N.
        Suspicious findings at digital breast Tomosynthesis occult to conventional digital mammography: imaging features and pathology findings.
        Breast J. 2015; 21: 538-542
        • Lamb P.M.
        • Perry N.M.
        • Vinnicombe S.J.
        • Wells C.A.
        Correlation between ultrasound characteristics, mammographic findings and histological grade in patients with invasive ductal carcinoma of the breast.
        Clin Radiol. 2000; 55: 40-44
        • Knutzen A.M.
        • Gisvold J.J.
        Likelihood of malignant disease for various categories of Mammographically detected.
        Nonpalpable Breast Lesions Mayo Clin Proc. 1993; 68: 454-460
        • Carney P.A.
        • Sickles E.A.
        • Monsees B.S.
        • et al.
        Identifying minimally acceptable interpretive performance criteria for screening mammography.
        Radiology. 2010; 255: 354-361
        • Sprague B.L.
        • Arao R.F.
        • Miglioretti D.L.
        • et al.
        National Performance Benchmarks for modern diagnostic digital mammography: update from the breast cancer surveillance consortium.
        Radiology. 2017; 283: 59-69
        • Lee C.S.
        • Bhargavan-Chatfield M.
        • Burnside E.S.
        • Nagy P.
        • Sickles E.A.
        The National Mammography Database: preliminary data.
        Am J Roentgenol. 2016; 206: 883-890
        • Schrading S.
        • Distelmaier M.
        • Dirrichs T.
        • Detering S.
        • Brolund L.
        • Strobel K.
        • et al.
        Digital breast tomosynthesis-guided vacuum-assisted breast biopsy: initial experiences and comparison with prone stereotactic vacuum-assisted biopsy.
        Radiology. 2015; 274: 654-662
      1. Sabatino V et al. Use of digital breast tomosynthesis as a guide in a consecutive series of 178 vacuum assisted biopsies: feasibility and clinical usefulness. Presented on Nov. 29, 2016 at the Radiological Society of North America 2016 scientific assembly and annual meeting, Chicago IL, 2016.

        • Siu A.L.
        • et al.
        Screening for breast cancer: preventive services task force recommendation statement.
        Ann Intern Med. 2016; 164: 279-296
        • Welch H.G.
        • Prorok P.C.
        • O'Malley A.J.
        • Kramer B.S.
        Breast-cancer tumor size, Overdiagnosis, and mammography screening effectiveness.
        N Engl J Med. 2016; 375: 1438-1447
        • Yeh E.D.
        • Slanetz P.J.
        • Edmister W.B.
        • Talele A.
        • Monticciolo D.
        • DBSO Kopans
        Invasive lobular carcinoma: spectrum of enhancement and morphology on magnetic resonance imaging.
        Breast J. 2003; 9: 13
      2. Moy L, Elias K, Patel V, Lee J, Babb J, Toth H, Mercado C. Is Breast MRI Helpful in the evaluation of inconclusive mammographic findings? Am J Roentgenol 2009;193: 986–993.

        • Evans W.P.
        • Warren Burhenne L.J.
        • Laurie L.
        • O'Shaughnessy K.F.
        • Castellino R.A.
        Invasive lobular carcinoma of the breast: mammographic characteristics and computer-aided detection.
        Radiology. 2002; 225: 182-189
        • Yankaskas B.C.
        • Schell M.J.
        • Bird R.E.
        • Desrochers D.A.
        Reassessment of breast cancers missed during routine screening mammography: a community-based study.
        Am J Roentgenol. 2001; 177: 535-541
        • Zuley M.L.
        • Bandos A.I.
        • Ganott M.A.
        • et al.
        Digital breast tomosynthesis versus supplemental diagnostic mammographic views for evaluation of noncalcified breast lesions.
        Radiology. 2013; 266: 89-95
      3. ECOG-ACRIN Cancer Research Group. Comparison of abbreviated breast mri and digital breast tomosynthesis in breast cancer screening in women with dense breasts. Randomized clinical trial (October 2016-present).