Background: Breast imagers detect non-palpable breast lesions that require accurate preoperative image-guided localization to optimize surgical outcomes. Mammographic localization has been performed for decades with a conventional mammogram unit utilizing an alphanumeric grid and two orthogonal view approach. However, digital breast tomosynthesis (DBT) allows additional strategies for mammographic localization on conventional mammogram and biopsy units. Furthermore, the lateral arm DBT approach provides additional benefits over the traditional vertical DBT approach. The lateral arm DBT approach has unique advantages over standard 2D mammographic and traditional vertical DBT approach localization, including decreased procedure time, improved patient comfort, decreased radiation dose, and mitigation of the accordion effect. Breast imagers should be aware of the unique advantages of lateral arm DBT approach to provide optimal localization for patients and referring surgeons.
Learning Objectives: • Review differences between standard 2D mammographic and DBT localization techniques • Understand lateral arm vs traditional vertical approach for DBT localization • Learn how to successfully perform lateral arm DBT localization
Abstract Content/Results: This presentation will review of mammographic localization techniques with approximately ten case examples of lateral arm DBT radioactive seed localization, including preoperative imaging, localization imaging and final pathology results. Cases will include both single site and multi-site localizations with various localization targets, including a tissue marker clip, landmarks with displaced tissue marker clip, lesions best seen on tomosynthesis, and calcifications. A pictorial guide to successfully perform lateral arm DBT localization will be presented, including tips and tricks for the radiologist.
Conclusion: Lateral arm DBT-guided preoperative localization offers advantages over standard 2D mammographic-guided and vertical approach DBT-guided techniques but may be underutilized. We aim to familiarize breast imagers with the lateral arm DBT technique through a pictorial step-by-step guide and case examples.
