Duration 8:42
Dr. Wear discusses her background with ultrasound vacuum assisted biopsy, selection criteria for specific products and equipment. Additionally, insights are provided on the role of the radiologist, pathologist, and technologist.
What I've chosen to speak about is my journey through the breast biopsy world. These are my disclaimers. So I do. We want to have to get a show of hands of who out there is using the magnum. Anyone, anyone using the monopoly, anyone using the finesse and anyone using the elevation. So this is my journey. I started as a resident using the magnum the reusable core biopsy device. It's still tried and true. Still out there, some of my partners still use it when I am finished residency and fellowship, we switch to monopoly, which is also a great disposable device. When finesse came out, I was one of the first users. I loved the device and then started hating the device. But now can happily say that I like the elevation as one of the best devices that I use to this day. There's multiple reasons why I like the elevation device. Every single one on the screen. The first most important in my opinion is tether list. So this is what the device looks like when it comes to you. There's a charger that you plug in the wall, but there are no cords. So it's very easy to manipulate, to move in and around the patient. There's nothing to trip over single insertion and multiple samples. So for other devices where you take a sample, take it out, you hand it to your nurse or you have to put it in the formula and then you put it back in. This device allows you to go into the breast one time and take multiple samples, different areas of the biopsied mass. Um You can reprime while in the breast. So you can fire and prime in the breast. If you want to take samples from different parts of the mass that you're sampling, it does have what's called a smart mode. So it knows when it needs to increase the vacuum. The tip is extremely sharp. So when I look at doing breast biopsies, the patient for me is obviously the most important. Our job here is to detect early breast cancer on the flip side of the patient. There's the radiologist, the technologist and the pathologist that I also kind of take into consideration when I'm doing breast biopsies. So for the radiologist, the device is important that its light weight, that it has a comfortable grip and that the buttons are simple. Let's keep this simple. We don't wanna have too many buttons when looking at different devices. I always want to make sure I have an adequate or a good sample size and that it's time efficient. Again, that tether this word is showing up which I really like. And again, single insertion with multiple samples. This is an example here of uh a fairly large mass. Here's the pre biopsy images. And as you can see as we go across this biopsy needles here on the top of the mass and then in the middle of the mass lower in the mass and in the bottom of the mass. So whenever I have big masses, I'm always a little bit concerned that I'm going to under sample the masses. So this ability to take different samples in different places while staying in the breast um allows me to feel a little bit better that I'm testing all of the mass that needs to be tested. So this is a hot topic that I've had discussions about whether to fire or not to fire in the breast, so or to fire at all. So what you can do with this device is you can fire outside of the breast and then manually push in to the mass that you're sampling and take samples. I like to fire because it helps me get through dense breast tissue. Also helps me get into those dense hard masses that are really hard to get the needle into. I will say the only downfall is it does produce a fairly loud noise. Uh usually as, as long as you're warning the patient, it's not too much of a big deal, but on the no fire aspect that is quieter, less disturbing to the patient and some people use it for the axilla. So they're not worried about firing into the axilla. Another example of firing into different areas of the breast. This is the pre biopsy image. Uh Here we are at the top of the mass, on the bottom of the mass and in the middle of the mass, all staying in the breast at the same time, I also sometimes run into as many of you do uh finding a mass that I want to sample. But as soon as I take the first sample, the mass either significantly decreases in size or quote goes away. If I was using a biopsy device that had to come out each time, it might be extremely difficult to take additional samples around the mass that originally I was targeting. But with this device, I'm able to keep the needle in place and just rotate my needle from 1236 and nine and get some samples from the entire area where that original mass was similarly a partially solid, partially cystic mass. That as I took my first sample of the solid component, some of the fluid was also sucked into the vacuum device. So after the fourth sample, it's barely visualized, but I was still able to feel like I adequately sampled that mass. So time is of the essence with me, I feel like I if I was a patient, I would not want to be on the biopsy table with a needle in my breast for 1015 minutes. So this elevation device has allowed me to really improve my biopsy speed. Here, you can see the time stamps. This is my first sample at 8 49 08 seconds and the clip insertion at 849 and 55 seconds. So I was able to obtain four samples and put in a clip within a minute. Moving on to what I also think is essential for our team as a pathologist. When I asked the pathologist, what they wanna see for me or what they want me to give in their specimen, they want adequate sample size so they can run all of their tests and all of their stains when I kind of think of this is my technologists are the ones who are with the patient more than I am, right. I'm in there, I'm doing my biopsy and then I'm out of the room, they're holding pressure, they're talking to the patient. So if we can make this experience better for the patient, that also makes the experience better for the technologist. So when I first started my practice here in Chicago, no one put markers in the masses. As a fellow, I trained in breast imaging and I was taught to always put clips in masses for multiple reasons. But even still to this day, I get a lot of outside consults from other institutions that don't have markers in the biopsied masses. Multiple reasons why I do, it helps for preoperative localization. I know where I need to go to get that mass taken out. It assists the surgeon in neoadjuvant chemotherapy cases when the mask is completely shrunk or disappears. And it also allows pathology to confirm that the pathology specimen is correct in locating the mass. Also, for many of you, I'm sure when I do an ultrasound biopsy, I do post biopsy mammograms so that I can actually say this mass has a clip in it and it matches the mass that I saw under mammography originally and it also A I DS development or follow up on benign masses. So if someone comes from an outside institution and they have a, what looks like a fibroadenoma and a clip is there and it hasn't changed. I feel a little bit safer until I get the pathology report to confirm that it is in it. It was benign multiple different clips um that we use at my institution. I tend to have at least six different clips on site at all times. Um, six is usually the most biopsies I'll do on one patient at a time and I like to make each mass have a different clip just so when the pathology comes out or if we have to go to surgery, we know what mass is associated with what clip. Another thing I use is the core light. So before I had the core light, I have three mammogram rooms. I would be doing my biopsy in one of the mammogram rooms. I would have to hold a second mammogram room so I can do my specimen to make sure I have my calcifications. So during biopsy times I go from three rooms down to one room and it just was not feasible. So the core light changed our workflow and has been wonderful. It's an easy to use system, very small footprint. This is the size of the device it sits on the counter in our biopsy room. It's a touch screen which makes life so easy and then it sends images automatically to pack. This is just an example here of what the coli specimen looks like. You can see the calcifications in that specimen. Thank you.
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