title: A novel semi-robotized device for high-precision18F-FDG-guided breast cancer biopsy.
abstract: OBJECTIVE
  To assess the 3D geometric sampling accuracy of a new PET-guided system for breast cancer biopsy (BCB) from areas within the tumour with high18F-FDG uptake.
  
  
  METHODS
  In the context of the European Union project MammoCare, a prototype semi-robotic stereotactic prototype BCB-device was incorporated into a dedicated high resolution PET-detector for breast imaging. The system consists of 2 stacked rings, each containing 12 plane detectors, forming a dodecagon with a 186mm aperture for 3D reconstruction (1mm3voxel). A vacuum-assisted biopsy needle attached to a robot-controlled arm was used. To test the accuracy of needle placement, the needle tip was labelled with18F-FDG and positioned at 78 target coordinates distributed over a 35mm×24mm×28mm volume within the PET-detector field-of-view. At each position images were acquired from which the needle positioning accuracy was calculated. Additionally, phantom-based biopsy proofs, as well as MammoCare images of 5 breast cancer patients, were evaluated for the 3D automated locating of18F-FDG uptake areas within the tumour.
  
  
  RESULTS
  Needle positioning tests revealed an average accuracy of 0.5mm (range 0-1mm), 0.6mm (range 0-2mm), and 0.4mm (range 0-2mm) for the x/y/z-axes, respectively. Furthermore, the MammoCare system was able to visualize and locate small (<10mm) regions with high18F-FDG uptake within the tumour suitable for PET-guided biopsy after being located by the 3D automated application.
  
  
  CONCLUSIONS
  Accuracy testing demonstrated high-precision of this semi-automatic 3D PET-guided system for breast cancer core needle biopsy. Its clinical feasibility evaluation in breast cancer patients scheduled for neo-adjuvant chemotherapy will follow.
authors.affiliation: Department of Nuclear Medicine, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
authors.forename: D
authors.initials: D
authors.lastname: Hellingman
authors.affiliation: Department of Nuclear Medicine, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
authors.forename: S C
authors.initials: SC
authors.lastname: Teixeira
authors.affiliation: Department of Nuclear Medicine, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
authors.forename: M L
authors.initials: ML
authors.lastname: Donswijk
authors.affiliation: Department of Medical Physics and Technology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
authors.forename: E J
authors.initials: EJ
authors.lastname: Rijkhorst
authors.affiliation: Instituto de Instrumentación para Imagen Molecular (I3M), Universidad Politécnica de Valencia, Camino de Vera s/n, 46022 Valencia, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Moliner
authors.affiliation: General Equipment for Medical Imaging S.A., C/Jerónimo de Monsoriu, 92, Bajo izq., 46022 Valencia, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Alamo
authors.affiliation: Department of Radiology, The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
authors.forename: C E
authors.initials: CE
authors.lastname: Loo
authors.affiliation: Department of Nuclear Medicine, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands; Interventional Molecular Imaging Laboratory and Nuclear Medicine Section, Department of Radiology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands. Electronic address: r.valdes@nki.nl.
authors.forename: R A
authors.initials: RA
authors.lastname: Valdés Olmos
authors.affiliation: Department of Nuclear Medicine, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
authors.forename: M P M
authors.initials: MPM
authors.lastname: Stokkel
mesh_terms: D001707:Biopsy, Needle / Q000295:instrumentation; D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000473:pathology*; D004867:Equipment Design; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D061705:Image-Guided Biopsy / Q000295:instrumentation; D019275:Radiopharmaceuticals; D065287:Robotic Surgical Procedures
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: (18)F-FDG-assisted biopsy; 3D PET-guided tumour location; Biopsia asistida por (18)F-FDG; Breast cancer; Caracterización tumoral; Cáncer de mama; Localización tumoral en 3D guiada por PET; Tumour characterization