Lateral-arm approach decreases clip migration in stereotactic breast biopsies

Abstract

Aim: Stereotactic-guided vacuum-assisted biopsy (STVAB) is the standard of care to biopsy mammographically detected breast lesions without a sonographic correlate. It can be performed using the conventional (CBA) or lateral-arm biopsy approach (LABA). Tissue marker (clip) placement is routinely done post-biopsy. Clip migration is frequently encountered in STVAB and can result in higher rates of positive margins and re-excision in subsequent surgery. We sought to compare clip migration rates between CBA and LABA.

Materials and methods: We performed a retrospective review of 347 cases performed at an Asian institution from 2021 to 2024, on predominantly dense breasts. We compared clip migration rates between CBA and LABA. Other factors that were known to contribute to clip migration were also studied, including breast density and hematoma size. Statistical analysis was done using Fisher's exact test, Mann-Whitney U test and linear regression models.

Results: A total of 347 biopsies were performed in 347 patients. CBA was performed for 297 (85.6 %) patients and LABA was performed for 50 (14.4 %). LABA was found to significantly reduce clip migration rates compared to CBA (4 % versus 25.9 %, p < 0.001). Breast density (p = 0.55) andhematoma size (p = 0.662) were not found to significantly affect clip migration rates.

Conclusion: We recommend utilizing LABA over CBA whenever technically possible if we wish to minimize clip migration.

Keywords: Breast biopsy; Breast imaging; Clip migration; Lateral arm approach; Stereotactic biopsy.