Processing stereotactic breast biopsy specimens: impact of specimen radiography system on workflow.

To the Editor: After breast tissue cores are obtained from a patient during a stereotactic biopsy performed for suspicious calcifications with potential atypia and/or breast malignancy, the presence of target calcifications within the tissue cores must be verified before sending the tissue to pathology. At our breast imaging center, there are two commercial imaging systems being used for this, the Bioptics CoreVision System, located in the biopsy room, and the GE 2000D System, which is a free-standing mammography unit located outside the biopsy room. They are essentially equivalent in terms of specimen radiography capabilities. The only difference is the location of the equipment and the rapidity of acquiring a specimen radiograph of the core tissue samples. The Bioptics unit allows for quickly evaluating the core tissue specimens in the biopsy room and efficiently transferring them to the collection jars sent to pathology. Otherwise, the core tissue specimens must be taken out of the biopsy room to the reading room workstation for specimen radiograph evaluation and separating core samples before sending them to pathology. This is relevant for institutions where the specimen is separated into “with calcifications” and “without calcifications” collection jars, which is often standard operating procedure. This also obviates the need to “hold” another mammography unit in a separate room, in addition to the biopsy unit, for obtaining the specimen images, which is an interruption in the usual work flow and an inconvenience for scheduled screening mammography patients. Using the Bioptics CoreVision increases overall efficiency of imaging the core tissue samples, and decreases time required to determine whether target calcifications are obtained so that a biopsy clip can be placed and the procedure completed. Prior to this study, the mammographers at our institution reported that although the overall quality of the two systems is equivalent, it seemed to take less time with one system compared with the other. Although there have been reports on interpretation workflow in mammography (1–4), as well as biopsy procedure times (e.g., patient positioning and needle localization times) (5,6), there have been no reports in the literature on this topic to date. Therefore, this study determined how long it takes mammographers to process core tissue samples from stereotactic core needle biopsies performed for suspicious breast calcifications with one system versus the other. The study was Institutional Review Board exempt. There were no deviations in the normal biopsy and specimen processing routine. Two mammographers used a form to record 3 key time points in the specimen processing routine. They completed it for 27 specimens with the GE 2000D unit and 27 with the Bioptics CoreVision unit, alternating for every other patient. Each mammographer completed half the cases. For each specimen, they recorded the time that (a) core tissue samples were placed in a tray for acquiring specimen radiography (“imaging of the specimen tray”), (b) they placed the biopsy clip in the breast following specimen radiography that showed the presence of target calcifications (“placement of biopsy clip”), and (c) when core tissue samples were transferred from the imaging tray to the specimen container that was subsequently sent to pathology (“placement of tissue cores in specimen container for histology”). For each case, the specimen radiography system used, the date, and which mammographer performed the procedure were recorded. The data for each step and the overall combined time were analyzed with an ANOVA. There was a significant difference in total time (F = 18.556, p < 0.0001) for Bioptics CoreVision versus GE. There was also a significant difference as a function of user (F = 6.397, p = 0.0146), although both users took Address correspondence and reprint requests to: Elizabeth A. Krupinski, PhD, Department of Radiology, University of Arizona, 1609 N Warren Bldg 211, Tucson, AZ 85724, USA, or e-mail: [email protected].