Tomosynthesis Guided Biopsy: When 3D Targeting Helps

What tomosynthesis guided biopsy is

Conventional stereotactic biopsy calculates the position of a target from two angled 2D images. In tomosynthesis biopsy, the target is identified on the reconstructed slices and its coordinates are calculated from the tomosynthesis dataset, then the needle is positioned accordingly.

The method is useful when a finding is visible on tomosynthesis but poorly seen on 2D, which is the case for some architectural distortions and subtle masses. For the foundations read stereotactic breast biopsy explained and digital breast tomosynthesis explained.

Tomosynthesis vs stereotactic biopsy: practical differences

Targeting in the slices can make it easier to localise findings that are subtle on 2D, and some centres find it shortens the search for the target. Procedure time still depends on the number of lesions, the device and the team, so measure it in your own practice.

The 2D stereotactic method remains well established for microcalcifications, where specimen radiography confirms retrieval. Many centres therefore want both capabilities on one platform. The decision for each patient is made by the radiologist, based on how the lesion is best seen.

• Target identified on tomosynthesis slices
• Useful for subtle distortions and masses
• Stereotactic 2D remains well established for calcifications
• Specimen radiography still applies

Stereotactic biopsy for architectural distortion

Architectural distortion may be subtle on 2D and appear more clearly on slices, which is a common reason to consider tomosynthesis guidance. The decision depends on whether the finding is visible on the guidance modality and on local protocols.

If a finding is also visible on ultrasound, another guidance method may be chosen; see stereotactic biopsy vs ultrasound-guided biopsy. Always correlate imaging and pathology results.

Equipment: Villa Melody IIID TS and upgrade path

The Melody IIID TS supports tomo-guided biopsy with the optional SBD DMD 3D device. The manufacturer lists a biopsy targeting accuracy of ±0.1 mm, three tomosynthesis scan angles up to 50° and scan times from 2.5 s with the Fast a-Se detector.

The Melody IIID is listed as field-upgradable to tomosynthesis and tomo-guided biopsy, with an optional stereotactic biopsy system, so a centre can start with 2D stereotactic capability and add tomo-guided biopsy later. Confirm the upgrade scope, downtime and cost basis in writing.

CPT code for tomosynthesis guided biopsy and billing

The CPT code for tomosynthesis guided biopsy is usually reported within the stereotactic biopsy family, with 19081 commonly referenced for the first lesion and 19082 for each additional lesion. Coding rules are revised regularly, so verify them against the current edition and the authority's schedules.

See our billing reference on mammography CPT codes. Also check the licensing requirements for a biopsy service with MOHAP, DHA or DOH.

Planning the service

Define the lesion mix, case volume and staffing, then specify the equipment: a tomosynthesis-capable unit, tomo-guided biopsy device, workstation, specimen radiography and a marker policy. Train radiologists and technologists and audit radiology-pathology concordance.

Beckfinity's specialists can prepare a configuration for your breast centre in the UAE. See also the comparison of biopsy chair and prone table options.