Journal of Breast Cancer C A S E R E P O R T J Breast Cancer 2011 March; 14(1): 64-68 DOI: 10.4048/jbc.2011.14.1.64 Lateral Decubitus Positioning Stereotactic Vacuum-Assisted Breast Biopsy with True Lateral Mammography Youn Joo Jung, Young Tae Bae1, Jee Yeon Lee1, Hyung-Il Seo1, Jee Yeon Kim2, Ki Seok Choo3 Breast Cancer Center, Departments of 1Surgery, 2Pathology, Pusan National University Hospital, Busan; 3Department of Radiology, Yangsan Pusan National University Hospital, Pusan National University School of Medicine, Yangsan, Korea Stereotactic vacuum-assisted breast biopsy (VAB) has been used to evaluate microcalcifications or non-palpable breast le- sions on mammography. Although stereotactic VAB is usually performed in a prone or upright position, an expensive prone ta- ble is necessary and vasovagal reactions often occur during the procedure. For these reasons, the lateral decubitus position can be applied for stereotactic VAB, and true lateral mammography can be used to detect the lesion. We report on 15 cases of later- al decubitus positioning for stereotactic VAB with true lateral mammography for non-palpable breast lesions or microcalcifi- cations. The mean procedure time was approximately 30.1 min- utes, and no complications occurred during the procedures. Four- teen cases had benign breast lesions and one case had a ductal carcinoma in situ. The lateral decubitus stereotactic VAB with true lateral mammography can be applied for microcalcifications or non-palpable breast lesions and helps to minimize anxiety and vasovagal reactions in patients. Key Words: Stereotactic techniques, Breast biopsy, Lateral positioning, Mammography INTRODUCTION Microcalcified or non-palpable breast lesions represent 6- 35% of beast malignancies [1,2]. However, it is difficult to tar- get the exact site of a microcalcification or non-palpable breast lesion if it is not detectable by ultrasound. Because stereotactic vacuum-assisted breast biopsy (VAB) has a higher accuracy rate using a horizontal (x), vertical (y), and depth (z)-axis com- pared with ultrasound-guided VAB for breast microcalcifica- tion or non-palpable lesions, it has been used as a reliable tech- nique to localize and sample those breast lesions [3,4]. Further- more, if the targeting is successful, it is easier than ultrasound- guided VAB or surgical biopsy. Stereotactic VAB is usually performed in a prone or upright position. However, an expensive, dedicated prone table is nec- essary to perform prone-positioned stereotactic VAB. Addi- tionally, there are some limitations to upright stereotactic VAB, Correspondence: Young Tae Bae Department of Surgery, Pusan National University Hospital, 305 Gudeok-ro, Seo-gu, Busan 602-739, Korea Tel: +82-51-240-7238, Fax: +82-51-247-1365 E-mail: bytae@pusan.ac.kr This study was supported by Medical Research Institute Grant (2002-24), Pusan National University Hospital. Received: August 19, 2010 Accepted: November 17, 2010 © 2011 Korean Breast Cancer Society such as inconvenience or a vasovagal reaction of patients [2,5,6]. Although the lateral decubitus position is an alternative posi- tion for stereotactic VAB, the breast lesion often moves in the lateral decubitus position, as identified in cranio-caudal (CC) or mediolateral-oblique (MLO) mammography views [7]. There- fore, a true lateral mammography view is needed to overcome this problem, which is nearly identical to stereotactic mammog- raphy in a lateral decubitus position. We used the lateral decubitus position during stereotactic VAB combined with true lateral mammography on 15 patients. CASE REPORT Between January and June 2010, we performed stereotactic directional VAB on 15 patients at the Breast Cancer Center of Pusan National University Hospital. In all cases, the CC and MLO mammography planes were preferentially reviewed to identify non-palpable lesions with or without microcalcifica- tions, and those lesions were classified according to the Breast Imaging Reporting and Data System (BI-RADS). True lateral views of the mammographic images (GE Medical Systems, Milwaukee, USA) were obtained in all cases before lateral de- cubitus positioning for stereotactic VAB. The patient laid on a stereotactic VAB table (Digital Stereo- taxy with Senographe DS Interventional; GE Medical Systems) http://ejbc.kr | pISSN 1738-6756 eISSN 2092-9900