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Yang Y, Wang J. Research on breast cancer pathological image classification method based on wavelet transform and YOLOv8. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2024; 32:677-687. [PMID: 38189740 DOI: 10.3233/xst-230296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Breast cancer is one of the cancers with high morbidity and mortality in the world, which is a serious threat to the health of women. With the development of deep learning, the recognition about computer-aided diagnosis technology is getting higher and higher. And the traditional data feature extraction technology has been gradually replaced by the feature extraction technology based on convolutional neural network which helps to realize the automatic recognition and classification of pathological images. In this paper, a novel method based on deep learning and wavelet transform is proposed to classify the pathological images of breast cancer. Firstly, the image flip technique is used to expand the data set, then the two-level wavelet decomposition and reconfiguration technology is used to sharpen and enhance the pathological images. Secondly, the processed data set is divided into the training set and the test set according to 8:2 and 7:3, and the YOLOv8 network model is selected to perform the eight classification tasks of breast cancer pathological images. Finally, the classification accuracy of the proposed method is compared with the classification accuracy obtained by YOLOv8 for the original BreaKHis dataset, and it is found that the algorithm can improve the classification accuracy of images with different magnifications, which proves the effectiveness of combining two-level wavelet decomposition and reconfiguration with YOLOv8 network model.
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Affiliation(s)
- Yunfeng Yang
- Department of Mathematics and Statistics, Northeast Petroleum University, Daqing, China
| | - Jiaqi Wang
- Department of Mathematics and Statistics, Northeast Petroleum University, Daqing, China
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The Potential of Adding Mammography to Handheld Ultrasound or Automated Breast Ultrasound to Reduce Unnecessary Biopsies in BI-RADS Ultrasound Category 4a: A Multicenter Hospital-Based Study in China. Curr Oncol 2023; 30:3301-3314. [PMID: 36975464 PMCID: PMC10047589 DOI: 10.3390/curroncol30030251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/04/2023] [Accepted: 03/09/2023] [Indexed: 03/14/2023] Open
Abstract
The appropriate management strategies for BI-RADS category 4a lesions among handheld ultrasound (HHUS) remain a matter of debate. We aimed to explore the role of automated breast ultrasound (ABUS) or the second-look mammography (MAM) adjunct to ultrasound (US) of 4a masses to reduce unnecessary biopsies. Women aged 30 to 69 underwent HHUS and ABUS from 2016 to 2017 at five high-level hospitals in China, with those aged 40 or older also accepting MAM. Logistic regression analysis assessed image variables correlated with false-positive lesions in US category 4a. Unnecessary biopsies, invasive cancer (IC) yields, and diagnostic performance among different biopsy thresholds were compared. A total of 1946 women (44.9 ± 9.8 years) were eligible for analysis. The false-positive rate of category 4a in ABUS was almost 65.81% (77/117), which was similar to HHUS (67.55%; 127/188). Orientation, architectural distortion, and duct change were independent factors associated with the false-positive lesions in 4a of HHUS, whereas postmenopausal, calcification, and architectural distortion were significant features of ABUS (all p < 0.05). For HHUS, both unnecessary biopsy rate and IC yields were significantly reduced when changing biopsy thresholds by adding MAM for US 4a in the total population (scenario #1:BI-RADS 3, 4, and 5; scenario #2: BI-RADS 4 and 5) compared with the current scenario (all p < 0.05). Notably, scenario #1 reduced false-positive biopsies without affecting IC yields when compared to the current scenario for ABUS (p < 0.001; p = 0.125). The higher unnecessary biopsy rate of category 4a by ABUS was similar to HHUS. However, the second-look MAM adjunct to ABUS has the potential to safely reduce false-positive biopsies compared with HHUS.
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Casal-Guisande M, Comesaña-Campos A, Dutra I, Cerqueiro-Pequeño J, Bouza-Rodríguez JB. Design and Development of an Intelligent Clinical Decision Support System Applied to the Evaluation of Breast Cancer Risk. J Pers Med 2022; 12:jpm12020169. [PMID: 35207657 PMCID: PMC8880667 DOI: 10.3390/jpm12020169] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/14/2022] [Accepted: 01/24/2022] [Indexed: 12/24/2022] Open
Abstract
Breast cancer is currently one of the main causes of death and tumoral diseases in women. Even if early diagnosis processes have evolved in the last years thanks to the popularization of mammogram tests, nowadays, it is still a challenge to have available reliable diagnosis systems that are exempt of variability in their interpretation. To this end, in this work, the design and development of an intelligent clinical decision support system to be used in the preventive diagnosis of breast cancer is presented, aiming both to improve the accuracy in the evaluation and to reduce its uncertainty. Through the integration of expert systems (based on Mamdani-type fuzzy-logic inference engines) deployed in cascade, exploratory factorial analysis, data augmentation approaches, and classification algorithms such as k-neighbors and bagged trees, the system is able to learn and to interpret the patient’s medical-healthcare data, generating an alert level associated to the danger she has of suffering from cancer. For the system’s initial performance tests, a software implementation of it has been built that was used in the diagnosis of a series of patients contained into a 130-cases database provided by the School of Medicine and Public Health of the University of Wisconsin-Madison, which has been also used to create the knowledge base. The obtained results, characterized as areas under the ROC curves of 0.95–0.97 and high success rates, highlight the huge diagnosis and preventive potential of the developed system, and they allow forecasting, even when a detailed and contrasted validation is still pending, its relevance and applicability within the clinical field.
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Affiliation(s)
- Manuel Casal-Guisande
- Department of Design in Engineering, University of Vigo, 36208 Vigo, Spain; (J.C.-P.); (J.-B.B.-R.)
- Department of Computer Sciences, Faculty of Sciences, University of Porto, 4169-007 Porto, Portugal;
- Center for Health Technologies and Information Systems Research–CINTESIS, Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
- Correspondence: (M.C.-G.); (A.C.-C.)
| | - Alberto Comesaña-Campos
- Department of Design in Engineering, University of Vigo, 36208 Vigo, Spain; (J.C.-P.); (J.-B.B.-R.)
- Center for Health Technologies and Information Systems Research–CINTESIS, Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
- Correspondence: (M.C.-G.); (A.C.-C.)
| | - Inês Dutra
- Department of Computer Sciences, Faculty of Sciences, University of Porto, 4169-007 Porto, Portugal;
- Center for Health Technologies and Information Systems Research–CINTESIS, Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
| | - Jorge Cerqueiro-Pequeño
- Department of Design in Engineering, University of Vigo, 36208 Vigo, Spain; (J.C.-P.); (J.-B.B.-R.)
- Center for Health Technologies and Information Systems Research–CINTESIS, Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
| | - José-Benito Bouza-Rodríguez
- Department of Design in Engineering, University of Vigo, 36208 Vigo, Spain; (J.C.-P.); (J.-B.B.-R.)
- Center for Health Technologies and Information Systems Research–CINTESIS, Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
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Dunne EC, Quinn EM, Stokes M, Barry JM, Kell M, Flanagan F, Kennedy MM, Walsh SM. Upgrade rates and outcomes of screen-detected atypical intraductal epithelial proliferation (AIDEP) diagnosed on core needle biopsy. Breast Dis 2021; 40:155-160. [PMID: 33749633 DOI: 10.3233/bd-201031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Atypical intraductal epithelial proliferation (AIDEP) is a breast lesion categorised as "indeterminate" if identified on core needle biopsy (CNB). The rate at which these lesions are upgraded following diagnostic excision varies in the literature. Women diagnosed with AIDEP are thought to be at increased risk of breast cancer. Our aim was to identify the rate of upgrade to invasive or in situ carcinoma in a group of patients diagnosed with AIDEP on screening mammography and to quantify their risk of subsequent breast cancer. METHODS We conducted a retrospective review of a prospectively maintained database containing all patients diagnosed with AIDEP on CNB between 2005 and 2012 in an Irish breast screening centre. Basic demographic data was collected along with details of the original CNB result, rate of upgrade to carcinoma and details of any subsequent cancer diagnoses. RESULTS In total 113 patients were diagnosed with AIDEP on CNB during the study period. The upgrade rate on diagnostic excision was 28.3% (n = 32). 6.2% (n = 7) were upgraded to invasive cancer and 22.1% (n = 25) to DCIS. 81 patients were not upgraded on diagnostic excision and were offered 5 years of annual mammographic surveillance. 9.88% (8/81) of these patients went on to receive a subsequent diagnosis of malignancy. The mean time to diagnosis of these subsequent cancers was 65.41 months (range 20.18-145.21). CONCLUSION Our data showing an upgrade rate of 28% to carcinoma reflects recently published data and we believe it supports the continued practice of excising AIDEP to exclude co-existing carcinoma.
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Affiliation(s)
- Emma C Dunne
- Department of Breast Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Edel M Quinn
- Department of Breast Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Maurice Stokes
- Department of Breast Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - John M Barry
- Department of Breast Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Malcolm Kell
- Department of Breast Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Fidelma Flanagan
- Department of Breast Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Margaret M Kennedy
- Department of Cellular Pathology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Siun M Walsh
- Department of Breast Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
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Choe AI, Ismail R, Mack J, Walter V, Yang AL, Dodge DG. Review of Variables Associated With Positive Surgical Margins Using Scout Reflector Localizations for Breast Conservation Therapy. Clin Breast Cancer 2021; 22:e232-e238. [PMID: 34348869 DOI: 10.1016/j.clbc.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/05/2021] [Accepted: 07/06/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To evaluate factors contributing to positive surgical margins associated with reflector guidance for patients undergoing breast conserving therapy for malignancy. MATERIALS AND METHODS A retrospective IRB-approved review of our institutional database was performed for malignant breast lesions preoperatively localized from January 1, 2018 to December 31, 2020. The following data was recorded using electronic medical records: lesion type and grade, lesion location, reflector and wire placement modality, use of intraoperative ultrasound, margin status, patient age, family history, BMI, and final pathology. Statistical analysis was performed with univariate summary statistics and logistic regression. P < .05 was significant. RESULTS A total of 606 image-guided pre-surgical localizations were performed for lumpectomies of breast malignancies. A total of 352 of 606 (58%) wire localizations and 254 of 606 (42%) SCOUT reflector localizations were performed. Sixty out of 352 (17%) of wire-localized patients had positive surgical margins, whereas forty-eight out of 254 (19%) of reflector-localized patients had positive surgical margins. (OR = 1.12, P value: .59). For reflector guided cases, the use of intraoperative ultrasound (IOUS) was associated with decreased positive margin status (OR = 0 .28, 95% CI = [0.14, 0.58]) while in situ disease was associated with increased positive margin status (OR = 1.99, 95% CI = [1.05, 3.75]). No association between modality used for localization (mammography vs. ultrasound) and positive margin status was observed (OR = 0.63, 95% CI = [0.33, 1.19]). No association between positive margins and age, family history, tumor location and BMI was observed. CONCLUSION For reflector guided surgeries, the use of IOUS was associated with decreased positive margins, by contrast the presence of ductal carcinoma in situ was associated with increased positive margins. There was no statistically significant difference in surgical outcomes for reflector-guided localization compared to wire localizations of the breast.
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Affiliation(s)
- Angela I Choe
- Penn State Health Milton S Hershey Medical Center, Hershey, PA.
| | | | - Julie Mack
- Penn State Health Milton S Hershey Medical Center, Hershey, PA
| | - Vonn Walter
- Penn State Health Milton S Hershey Medical Center, Hershey, PA
| | | | - Daleela G Dodge
- Penn State Health Milton S Hershey Medical Center, Hershey, PA
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Maimone S, Morozov AP, Wilhelm A, Robrahn I, Whitcomb TD, Lin KY, Maxwell RW. Understanding Patient Anxiety and Pain During Initial Image-guided Breast Biopsy. JOURNAL OF BREAST IMAGING 2020; 2:583-589. [PMID: 38424861 DOI: 10.1093/jbi/wbaa072] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Indexed: 03/02/2024]
Abstract
OBJECTIVE Image-guided breast biopsies are safe, efficient, and reliable. However, patients are often anxious about these procedures, particularly those who have never undergone a prior biopsy. METHODS This prospective IRB-approved study surveyed 163 patients undergoing their first breast biopsy. Participants provided informed consent and completed a short written survey prior to and immediately after their procedure. Level of anxiety as well as anticipated and actual levels of pain prior to and following the procedure were assessed using a 0-10-point Likert scale. Correlation, bivariate, and regression analyses were performed. RESULTS Regarding the biopsy experience, 133/163 (81.6%) of patients reported it as better than expected. Anxiety decreased significantly from a prebiopsy mean score of 5.52 to a postbiopsy mean score of 2.25 (P < 0.001). Average and greatest pain experienced during the procedure had mean scores of 2.03 and 2.77, respectively, both significantly lower compared to preprocedural expectation (mean 4.53) (P < 0.001). Lower pain scores were reported in US-guided procedures compared to stereotactic- and MRI-guided biopsies (P < 0.001). No significant differences in pain scores were seen in those undergoing single versus multiple biopsies, or when benign, elevated-risk, or malignant lesions were sampled. Positive correlations were seen with prebiopsy anxiety levels and procedural pain as well as with anticipated pain and actual procedural pain. CONCLUSION Image-guided biopsies are often better tolerated by patients than anticipated. We stress the benefit of conveying this information to patients prior to biopsy, as decreased anxiety correlates with lower levels of pain experienced during the procedure.
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Affiliation(s)
- Santo Maimone
- Mayo Clinic Florida, Department of Radiology, Jacksonville, FL
| | | | | | - Inna Robrahn
- Mayo Clinic Florida, Department of Radiology, Jacksonville, FL
| | | | - Kathryn Y Lin
- Mayo Clinic Rochester, Department of Immunology, Rochester, MN
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Kim KW, Park JH, Kim S, Ahn EJ, Kim HJ, Choi HR, Chang YG, Bang SR. The Effectiveness of Dexmedetomidine in Vacuum-Assisted Breast Biopsy Under Monitored Anesthesia Care. KOSIN MEDICAL JOURNAL 2019. [DOI: 10.7180/kmj.2019.34.1.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objectives Vacuum-assisted breast biopsy (VABB) is a widely used technique for the diagnosis of breast lesions. It is carried out with local anesthesia, but procedural pain and stress are still problematic. Dexmedetomidine is a α-2 receptor agonist that can sedate without significant respiratory depression. The study aimed to report the effectiveness of sedation with monitored anesthesia care (MAC) using dexmedetomidine in VABB. Methods This was a retrospective chart review of patients who received VABB under MAC with dexmedetomidine. Forty-seven patients during the period of February 2015 to July 2016 were included. We collected data on patient characteristics, infusion drug and dose, induction to incision time, anesthetic, operation, and recovery time and other complications and vital signs. Results The mean operating time was 50.1 ± 24.9 minutes, and the anesthetic time was 71.2 ± 28.3 minutes. The mean time from induction to incision was 17.0 ± 5.2 minutes, and the recovery time was 20.1 ± 10.3 minutes. None of the patients needed an advanced airway management. Further, none of them showed hemodynamic instability. Conclusions VABB was successfully performed with MAC using dexmedetomidine, and there was no respiratory depression or hemodynamic instability.
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Ciritsis A, Rossi C, Eberhard M, Marcon M, Becker AS, Boss A. Automatic classification of ultrasound breast lesions using a deep convolutional neural network mimicking human decision-making. Eur Radiol 2019; 29:5458-5468. [PMID: 30927100 DOI: 10.1007/s00330-019-06118-7] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/06/2019] [Accepted: 02/15/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To evaluate a deep convolutional neural network (dCNN) for detection, highlighting, and classification of ultrasound (US) breast lesions mimicking human decision-making according to the Breast Imaging Reporting and Data System (BI-RADS). METHODS AND MATERIALS One thousand nineteen breast ultrasound images from 582 patients (age 56.3 ± 11.5 years) were linked to the corresponding radiological report. Lesions were categorized into the following classes: no tissue, normal breast tissue, BI-RADS 2 (cysts, lymph nodes), BI-RADS 3 (non-cystic mass), and BI-RADS 4-5 (suspicious). To test the accuracy of the dCNN, one internal dataset (101 images) and one external test dataset (43 images) were evaluated by the dCNN and two independent readers. Radiological reports, histopathological results, and follow-up examinations served as reference. The performances of the dCNN and the humans were quantified in terms of classification accuracies and receiver operating characteristic (ROC) curves. RESULTS In the internal test dataset, the classification accuracy of the dCNN differentiating BI-RADS 2 from BI-RADS 3-5 lesions was 87.1% (external 93.0%) compared with that of human readers with 79.2 ± 1.9% (external 95.3 ± 2.3%). For the classification of BI-RADS 2-3 versus BI-RADS 4-5, the dCNN reached a classification accuracy of 93.1% (external 95.3%), whereas the classification accuracy of humans yielded 91.6 ± 5.4% (external 94.1 ± 1.2%). The AUC on the internal dataset was 83.8 (external 96.7) for the dCNN and 84.6 ± 2.3 (external 90.9 ± 2.9) for the humans. CONCLUSION dCNNs may be used to mimic human decision-making in the evaluation of single US images of breast lesion according to the BI-RADS catalog. The technique reaches high accuracies and may serve for standardization of highly observer-dependent US assessment. KEY POINTS • Deep convolutional neural networks could be used to classify US breast lesions. • The implemented dCNN with its sliding window approach reaches high accuracies in the classification of US breast lesions. • Deep convolutional neural networks may serve for standardization in US BI-RADS classification.
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Affiliation(s)
- Alexander Ciritsis
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
| | - Cristina Rossi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Matthias Eberhard
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Magda Marcon
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Anton S Becker
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Andreas Boss
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
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An evaluation of patient experience during percutaneous breast biopsy. Eur Radiol 2017; 27:4804-4811. [PMID: 28534164 DOI: 10.1007/s00330-017-4872-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 04/04/2017] [Accepted: 04/27/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Percutaneous breast biopsy in a tertiary referral high volume breast centre: can we improve the patient experience? PURPOSE The study was performed to evaluate patient experience during ultrasound-guided (UGB) and vacuum-assisted stereotactic breast biopsy (SBB) and determine what factors could improve the patient experience. METHODS Consecutive patients who underwent image guided breast biopsy from 01- 05/30, 2015 were approached in a structured telephone interview to evaluate pain and bruising from the procedure. Three hundred and fifty-one patients were interviewed (116 SBB and 235 UGB). Information about the radiologist performing the biopsy, biopsy type, needle gauge, and number of cores was collected from the biopsy reports. Correlation was done using Spearman rank test. RESULTS Average patient scores of pain with UGB and SBB were 2.3 and 3.1 (out of 10). There was a significant correlation between pain during SBB and physician experience (p = 0.013), and no correlation with pain during UGB (p > 0.05). No correlation was found between needle gauge and pain experienced during breast biopsy or between numbers of cores and pain (p > 0.05). Body position during SBB was mentioned to cause discomfort and pain in 28% of patients while during UGB was mentioned by 0.4% of patients. CONCLUSION SBB was inferior to UGB for patient experience, but years of radiologists' experience correlated with improved patient scores of pain for SBB. KEY POINTS • To achieve high quality, an institution must emphasise patient-centred care. • Increased radiologist training with stereotactic biopsy may contribute to improved patient experience. • Stereotactic breast biopsy was inferior to ultrasound biopsy for patient experience. • Radiologists' experience correlated with improved patient scores of pain for stereotactic biopsy.
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Sharma N, Wilkinson LS, Pinder SE. The B3 conundrum-the radiologists' perspective. Br J Radiol 2016; 90:20160595. [PMID: 27936888 DOI: 10.1259/bjr.20160595] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The management of B3 lesions is both controversial and complicated. There have been recent publications regarding how best to manage this heterogeneous group particularly in light of the Marmot Review and with the advent of vacuum-assisted biopsy technique. It is recognized that B3 lesions on core biopsy can be upgraded to malignancy in up to one-third of cases, but this is predominantly to ductal carcinoma in situ or low-grade invasive tumours. The upgrade rate is mainly associated with B3 lesions with epithelial atypia. This review summarizes the current management and focuses on the proposed future management of these B3 lesions.
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Affiliation(s)
- Nisha Sharma
- 1 Breast Unit, Level 1 Chancellor Wing, St James's Hospital, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | | | - Sarah E Pinder
- 3 Department of Breast Pathology, King's College London and Guy's Hospital, London, UK
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Ji T, Gao S, Liu Z, Xing H, Zhao G, Ma Q. 99mTc-Glu-c(RGDyK)-Bombesin SPECT Can Reduce Unnecessary Biopsy of Masses That Are BI-RADS Category 4 on Ultrasonography. J Nucl Med 2016; 57:1196-200. [PMID: 27013698 DOI: 10.2967/jnumed.115.168773] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 02/23/2016] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED Masses that, on ultrasonography, are category 4 according to the Breast Imaging Reporting and Data System (BI-RADS) represent possible malignancy, and a biopsy is recommended. This study explored the value of (99m)Tc-Glu-c(RGDyK)-bombesin ((99m)Tc-RGD-bombesin) in reducing unnecessary biopsy of these masses. METHODS Ninety women with a BI-RADS 4 mass on ultrasonography were enrolled in this study to undergo breast SPECT using (99m)Tc-RGD-bombesin. The images were independently interpreted using qualitative visual and semiquantitative analyses. The final diagnosis was based on histopathologic examination of surgically excised or percutaneous biopsy specimens. Fractions of the samples were immunohistochemically analyzed to evaluate expression of integrin αvβ3 and gastrin-releasing peptide receptor (GRPR). The receptor-positive group was further divided into 3 subgroups (GRPR(+)/αvβ3 (+), GRPR(+)/αvβ3 (-), and αvβ3 (+)/GRPR(-)). RESULTS Ninety-four masses (22 malignant and 72 benign) were confirmed by histopathologic examination. On qualitative analysis, 20 of the malignant masses showed high (99m)Tc-RGD-bombesin accumulation and 48 of the benign masses showed no (99m)Tc-RGD-bombesin accumulation. The optimal cutoff for qualitative analysis was a score of 2. Semiquantitative analysis revealed that 20 of the malignant masses and 16 of the benign masses had a relatively high tumor-to-normal-tissue ratio (T/N). The optimal cutoff was a T/N of 2.26. The mean T/N was higher for malignant masses than for benign masses (3.17 ± 0.86 vs. 1.89 ± 0.71, P < 0.05). T/Ns did not differ among the 3 subgroups (P > 0.05). The areas under the receiver-operating-characteristic curves for the qualitative and semiquantitative analyses were 0.788 and 0.865, respectively, and the overall diagnostic performance did not significantly differ between these analyses (P > 0.05). CONCLUSION (99m)Tc-RGD-bombesin SPECT can differentiate benign from malignant BI-RADS 4 masses with high specificity. Further study of the application of this test to clinical breast cancer appears warranted.
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Affiliation(s)
- Tiefeng Ji
- Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Shi Gao
- Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Zhaofei Liu
- Medical Isotopes Research Center, Peking University, Beijing, China; and
| | - Hua Xing
- Department of Breast Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Guoqing Zhao
- Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Qingjie Ma
- Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University, Changchun, China
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Pang E, Crystal P, Kulkarni S, Murphy K, Menezes RJ. An Audit of Pain Experienced During Image-Guided Breast Biopsy Procedures at an Academic Center. Can Assoc Radiol J 2016; 67:250-3. [PMID: 26831731 DOI: 10.1016/j.carj.2015.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 09/15/2015] [Accepted: 10/28/2015] [Indexed: 11/20/2022] Open
Affiliation(s)
- Emily Pang
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Pavel Crystal
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada; Joint Department of Medical Imaging, Toronto, Ontario, Canada
| | - Supriya Kulkarni
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada; Joint Department of Medical Imaging, Toronto, Ontario, Canada
| | - Kieran Murphy
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada; Joint Department of Medical Imaging, Toronto, Ontario, Canada
| | - Ravi J Menezes
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada; Joint Department of Medical Imaging, Toronto, Ontario, Canada.
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Application of a topical vapocoolant spray decreases pain at the site of initial intradermal anaesthetic injection during ultrasound-guided breast needle biopsy. Clin Radiol 2015; 70:938-42. [PMID: 26162573 DOI: 10.1016/j.crad.2015.04.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 04/04/2015] [Accepted: 04/13/2015] [Indexed: 11/23/2022]
Abstract
AIM To assess whether the application of a topical vapocoolant spray immediately prior to initial intradermal anaesthetic injection during ultrasound-guided breast biopsy decreases pain at the site of the initial injection. MATERIALS AND METHODS In this institutional review board-approved, Health Insurance Portability and Accountability Act (HIPAA)-compliant study, 50 women aged 49.1 ± 1.6 years (mean ± standard error) were recruited and provided written informed consent. Participants served as their own controls and were blinded as to whether a topical vapocoolant spray or a placebo was used immediately prior to the initial local anaesthetic injection at two separate biopsy sites. With the exception of the application of vapocoolant or placebo, the entire ultrasound-guided procedure was performed according to a routine protocol. Participants recorded pain at initial injection site on a visual analogue scale. General linear mixed models for repeated measures analysis of variance and a 0.05 significance level were used. RESULTS Application of topical vapocoolant spray was shown to significantly decrease pain at the site of initial intradermal anaesthetic injection as compared to placebo (p<0.001). Treatment effect was independent of age of the subject, race/ethnicity, operator, type of biopsy device, and histopathology result. No complications from vapocoolant spray use were reported. CONCLUSION Application of a topical vapocoolant spray immediately prior to initial intradermal anaesthetic injection during ultrasound-guided breast biopsy significantly decreases pain at the site of the initial injection and could contribute to improve the patient's overall procedural experience.
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Soo AE, Shelby RA, Miller LS, Balmadrid MH, Johnson KS, Wren AA, Yoon SC, Keefe FJ, Soo MS. Predictors of pain experienced by women during percutaneous imaging-guided breast biopsies. J Am Coll Radiol 2015; 11:709-16. [PMID: 24993536 DOI: 10.1016/j.jacr.2014.01.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 01/23/2014] [Indexed: 11/18/2022]
Abstract
PURPOSE The purpose of this study was to evaluate pain experienced during imaging-guided core-needle breast biopsies and to identify factors that predict increased pain perception during procedures. METHODS In this institutional review board-approved, HIPAA-compliant protocol, 136 women undergoing stereotactically or ultrasound-guided breast biopsy or cyst aspiration were recruited and provided written informed consent. Participants filled out questionnaires assessing anticipated biopsy pain, ongoing breast pain, pain experienced during biopsy, catastrophic thoughts about pain during biopsy, anxiety, perceived communication with the radiologist, chronic life stress, and demographic and medical information. Procedure type, experience level of the radiologist performing the biopsy, number of biopsies, breast density, histology, and tumor size were recorded for each patient. Data were analyzed using Spearman's ρ correlations and a probit regression model. RESULTS No pain (0 out of 10) was reported by 39.7% of women, mild pain (1-3 out of 10) by 48.5%, and moderate to severe pain (≥4 out of 10) by 11.8% (n = 16). Significant (P < .05) predictors of greater biopsy pain in the probit regression model included younger age, greater prebiopsy breast pain, higher anticipated biopsy pain, and undergoing a stereotactic procedure. Anticipated biopsy pain correlated most strongly with biopsy pain (β = .27, P = .004). CONCLUSIONS Most patients report minimal pain during imaging-guided biopsy procedures. Women experiencing greater pain levels tended to report higher anticipated pain before the procedure. Communication with patients before biopsy regarding minimal average pain reported during biopsy and encouragement to make use of coping strategies may reduce patient anxiety and anticipated pain.
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Affiliation(s)
- Adrianne E Soo
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Rebecca A Shelby
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Lauren S Miller
- Riverside Radiology and Interventional Associates, Columbus, Ohio
| | | | - Karen S Johnson
- Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | - Anava A Wren
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Sora C Yoon
- Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | - Francis J Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Mary Scott Soo
- Department of Radiology, Duke University Medical Center, Durham, North Carolina.
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Wu Y, Alagoz O, Vanness DJ, Trentham-Dietz A, Burnside ES. Pursuing optimal thresholds to recommend breast biopsy by quantifying the value of tomosynthesis. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2014; 9037:90370U. [PMID: 25076829 DOI: 10.1117/12.2042905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
A 2% threshold has been traditionally used to recommend breast biopsy in mammography. We aim to characterize how the biopsy threshold varies to achieve the maximum expected utility (MEU) of tomosynthesis for breast cancer diagnosis. A cohort of 312 patients, imaged with standard full field digital mammography (FFDM) and digital breast tomosynthesis (DBT), was selected for a reader study. Fifteen readers interpreted each patient's images and estimated the probability of malignancy using two modes: FFDM versus FFDM + DBT. We generated receiver operator characteristic (ROC) curves with the probabilities for all readers combined. We found that FFDM+DBT provided improved accuracy and MEU compared with FFDM alone. When DBT was included in the diagnosis along with FFDM, the optimal biopsy threshold increased to 2.7% as compared with the 2% threshold for FFDM alone. While understanding the optimal threshold from a decision analytic standpoint will not help physicians improve their performance without additional guidance (e.g. decision support to reinforce this threshold), the discovery of this level does demonstrate the potential clinical improvements attainable with DBT. Specifically, DBT has the potential to lead to substantial improvements in breast cancer diagnosis since it could reduce the number of patients recommended for biopsy while preserving the maximal expected utility.
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Affiliation(s)
- Yirong Wu
- Dept. of Radiology, UW Madison, Madison, WI, USA
| | - Oguzhan Alagoz
- Dept. of Industrial and Systems Engineering, UW Madison, WI, USA
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Reducing false-positive biopsies: a pilot study to reduce benign biopsy rates for BI-RADS 4A/B assessments through testing risk stratification and new thresholds for intervention. Breast Cancer Res Treat 2013; 139:769-77. [PMID: 23764994 PMCID: PMC3695318 DOI: 10.1007/s10549-013-2576-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 05/22/2013] [Indexed: 11/23/2022]
Abstract
The aim of this study is to evaluate Breast Imaging Reporting and Data Systems (BI-RADS) 4A/B subcategory risk estimates for ductal carcinoma in situ (DCIS) and invasive cancer (IC), determining whether changing the proposed cutoffs to a higher biopsy threshold could safely increase cancer-to-biopsy yields while minimizing false-positive biopsies. A prospective clinical trial was performed to evaluate BI-RADS 4 lesions from women seen in clinic between January 2006 and March 2007. An experienced radiologist prospectively estimated a percent risk-estimate for DCIS and IC. Truth was determined by histopathology or 4-year follow-up negative for malignancy. Risk estimates were used to generate receiver-operating characteristic (ROC) curves. Biopsy rates, cancer-to-biopsy yields, and type of malignancies missed were then calculated across postulated risk thresholds. A total of 124 breast lesions were evaluated from 213 women. An experienced radiologist gave highly accurate risk estimates for IC, DCIS alone, or the combination with an area under ROC curve of 0.91 (95 % CI 0.84–0.99) (p < 0.001), 0.81 (95 % CI 0.69–0.93) (p = 0.011), and 0.89 (95 % CI 0.83–0.95) (p < 0.001), respectively. The cancer-to-biopsy yield was 30 %. Three hypothetical thresholds for intervention were analyzed: (1) DCIS or IC ≥ 10 %; (2) DCIS ≥ 50 % or IC ≥ 10 %; and (3) IC ≥ 10 %, which translated to 22, 48, and 56 % of biopsies avoided; cancer-to-biopsy yields of 36, 47, and 46 %; and associated chance of missing an IC of 0, 1, and 2 %, respectively. Expert radiologists estimate risk of IC and DCIS with a high degree of accuracy. Increasing the cut off point for recommending biopsy, substituting with a short-term follow-up protocol with biopsy if any change, may safely reduce the number of false-positive biopsies.
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Szynglarewicz B, Kasprzak P, Kornafel J, Forgacz J, Pudelko M, Majewski A, Matkowski R. Duration time of vacuum-assisted biopsy for nonpalpable breast masses: Comparison between stereotactic and ultrasound-guided procedure. TUMORI JOURNAL 2011; 97:517-21. [DOI: 10.1177/030089161109700417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and background Minimally invasive biopsy should be a standard practice in the non-operative diagnosis of breast lesions that are suspicious for or highly suggestive of malignancy. The aim of this study was to compare the procedure duration time for different methods of minimally invasive image-guided vacuum-assisted breast biopsy (VABB). Methods Six hundred and ninety-one women with nonpalpable breast masses classified as BI-RADS IV or V were studied. All of them underwent minimally invasive percutaneous VABB with an 11-gauge needle. In 402 patients an ultrasound-guided procedure with a hand-held device was performed while in 289 women stereotactic biopsy was carried out using a dedicated prone table unit with digital imaging. In each case the duration of biopsy was measured in terms of the total procedure time, room time and physician time. Results There were no significant differences between the stereotactic and ultrasound-guided groups with regard to patient age, body mass index, menopausal status, history of parity, hormone replacement therapy, breast parenchymal pattern (according to Wolfe's classification), family history of breast cancer, mass size and number of samples. Ultrasound-guided biopsy was found to take significantly less time than prone stereotactic biopsy in every aspect of procedure duration. Mean total procedure time, room time, and physician time in minutes were 26.7 ± 8.2 vs 47.5 ± 9.4 (P <0.01), 23.1 ± 8.5 vs 36.5 ± 9.2 (P <0.05), and 12.3 ± 5.6 vs 18.6 ± 5.9 (P <0.05), respectively. Conclusions Ultrasound-guided breast biopsy is less time-consuming than the stereotactic procedure for both the patient and the physician. Because of the shorter procedure time (as well as other well-known advantages: real-time imaging, lower cost), ultrasound-guided biopsy should be considered the method of choice for sampling suspicious nonpalpable breast masses.
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Affiliation(s)
- Bartlomiej Szynglarewicz
- Second Department of Surgical Oncology, Lower Silesian Oncology Center, Regional Comprehensive Cancer Center, Wroclaw
| | - Piotr Kasprzak
- Breast Imaging and Minimal-Invasive Biopsy Service, Lower Silesian Oncology Center, Regional Comprehensive Cancer Center, Wroclaw
| | - Jan Kornafel
- Department of Oncology, Wroclaw Medical University, Wroclaw
| | - Jozef Forgacz
- Second Department of Surgical Oncology, Lower Silesian Oncology Center, Regional Comprehensive Cancer Center, Wroclaw
| | - Marek Pudelko
- Second Department of Surgical Oncology, Lower Silesian Oncology Center, Regional Comprehensive Cancer Center, Wroclaw
| | - Adam Majewski
- Department of Surgical Oncology, Sokolowski Hospital, Walbrzych, Poland
| | - Rafal Matkowski
- Second Department of Surgical Oncology, Lower Silesian Oncology Center, Regional Comprehensive Cancer Center, Wroclaw
- Department of Oncology, Wroclaw Medical University, Wroclaw
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Pain experienced by patients during minimal-invasive ultrasound-guided breast biopsy: vacuum-assisted vs core-needle procedure. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2011; 37:398-403. [PMID: 21367573 DOI: 10.1016/j.ejso.2011.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2010] [Revised: 01/23/2011] [Accepted: 02/08/2011] [Indexed: 11/21/2022]
Abstract
AIMS To evaluate comparatively the pain associated with ultrasound-guided core-needle (CN) and vacuum-assisted (VA) biopsy for non-palpable breast lesions. METHODS 723 women undergoing ultrasound-guided breast biopsy for BIRADS IV and V lesions according to the same standardised protocol were prospectively studied. 14-gauge CN biopsy with an automated gun was performed in 321 patients. In 402 women biopsy was made using 11-gauge VA hand-held probe. Immediately after the procedure patients were interviewed about the pain experienced during the biopsy and were asked to indicate at the pain intensity on a eleven-point scale: from 0 (none) to 10 (extreme, worst possible pain). RESULTS The median rate of pain experienced by women during biopsy was 4 (range 2-7). There were no significant differences between CN and VA groups with regard to age, body mass index, menopausal status, history of parity, hormone replacement therapy, menopausal status, breast parenchymal pattern (according to Wolfe's classification), family history of breast cancer, lesion size and number of samples. CN biopsy with an automated gun was significantly more painful (P < 0.01) than procedure with VA hand-held device as evaluated by patients: median 6 (4-7) vs 3 (2-5), respectively. CONCLUSIONS Despite using the larger needle VA procedure results in less pain experienced by women in comparison to CN biopsy with automated gun. Reduced patient discomfort should be one of the reasons for the preferential use of VA biopsy in the assessment of non-palpable breast masses.
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Preoperative cytological and histological diagnosis of breast lesions: A critical review. Eur J Surg Oncol 2010; 36:934-40. [PMID: 20709485 DOI: 10.1016/j.ejso.2010.06.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2010] [Revised: 05/20/2010] [Accepted: 06/07/2010] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Non-operative pathology diagnoses constitute an essential part of the work-up of breast lesions. With fine needle aspiration (FNA) and core needle biopsy (CNB) both having unique advantages, there is an increasing acceptance of CNB. This paper aims to outline the scientific basis of this trend. Additionally, we provide an update on novel techniques that derive cytological specimens from CNB (i.e., touch imprint (TI) and core wash (CW) cytology) in an attempt to get the best of both worlds. METHODS In addition to using the authors' experience, we performed a search of the Medline database combining the search terms "breast cancer diagnosis", "core needle biopsy", "fine needle aspiration", "touch imprint cytology", "core wash cytology" and "complications". We defined a conclusive non-operative diagnosis as "malignant" in lesions that were malignant on follow-up and "benign" in lesions that were benign on follow-up. RESULTS CNB was more often conclusive than FNA in benign and malignant lesions in 4 prospective studies. Although the more rapid diagnoses by FNA result in less patient anxiety during diagnostic work-up, CNB allows for fairly reliable estimation of invasion, histological type, grade, and receptor expression. CW and TI cytology seem promising techniques with conclusiveness rates that are roughly comparable to that of FNA. CONCLUSIONS All new suspicious breast lesions require careful non-operative investigation by CNB. However, additional cytological assessment by FNA can still be useful as a same-day diagnosis decreases patient anxiety and facilitates surgical treatment planning. TI and CW cytology techniques are promising same-day diagnosis modalities.
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Breast self-examination and adherence to mammographic follow-up: an intriguing diptych after benign breast biopsy. Eur J Cancer Prev 2010; 19:71-2. [PMID: 19901842 DOI: 10.1097/cej.0b013e32832926e8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This study evaluates the effect of palpability upon breast self-examination (BSE) and adherence to annual mammogram after benign breast biopsy (BBB). Seven hundred and fifty-two women with palpable (WP, n = 359) or nonpalpable (WNP, n = 393) lesions were evaluated 2 years before and after BBB. BSE was considered adequate when it was performed at least once per month, and inadequate when it was performed with a frequency of less than once per month. Prebiopsy/postbiopsy adherence was characterized as inadequate when at least one session of mammographic examination was lost within the 2-prebiopsy/postbiopsy (including the last visit) years, respectively. The prebiopsy frequency of adequate BSE was higher in WP [49 (176 of 359) vs. 38.9% (153 of 393) for WNP; Pearson's chi2 (1) = 7.77, P = 0.005]. However, the opposite happened regarding the prebiopsy adherence to mammogram, as the frequency of adequate adherence was 64.1% (252 of 393) in WNP, but only 46.0% (165 of 359) in WP. After BBB, adherence to mammogram significantly increased in both groups, reaching 76.1% (299 of 393) for WNP and 65.2% (234 of 359) for WP. However, BSE increased significantly only in WNP. Regarding the WP group, the postBBB BSE did not exhibit any significant change. Noticeably, the aforementioned increase in BSE among WNP resulted in the disappearance of the initial WP-WNP discrepancy regarding BSE; the postBBB BSE did not differ between WP and WNP. However, concerning adherence to mammogram, the superiority of WNP versus WP persisted (76.1 vs. 65.2%, respectively). In conclusion WP and WNP may perceive BBB differently, as reflected upon the differentially modified patterns.
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Volume of blood suctioned during vacuum-assisted breast biopsy predicts later hematoma formation. BMC Res Notes 2010; 3:70. [PMID: 20226029 PMCID: PMC2848056 DOI: 10.1186/1756-0500-3-70] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2009] [Accepted: 03/12/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate whether the volume of blood suctioned during vacuum-assisted breast biopsy (VABB) is associated with hematoma formation and progression, patient's age and histology of the lesion. FINDINGS 177 women underwent VABB according to standardized protocol. The volume of blood suctioned and hematoma formation were noted at the end of the procedure, as did the subsequent development and progression of hematoma. First- and second-order logistic regression was performed, where appropriate. Cases with hematoma presented with greater volume of blood suctioned (63.8 +/- 44.7 cc vs. 17.2 +/- 32.9 cc; p < 0.001, Mann-Whitney-Wilcoxon test for independent samples, MWW); the likelihood of hematoma formation was increasing till a volume equal to 82.6 cc, at which the second-order approach predicts a maximum. The volume of blood suctioned was positively associated with the duration of the procedure (Spearman's rho = 0.417, p < 0.001); accordingly, hematoma formation was also positively associated with the latter (p = 0.004, MWW). The volume of blood suctioned was not associated with patients' age, menopausal status and histopathological diagnosis. CONCLUSION The likelihood of hematoma is increasing along with increasing amount of blood suctioned, reaching a plateau approximately at 80 cc of blood lost.
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Domeyer PJ, Sergentanis TN, Zagouri F, Zografos GC. Health-related quality of life in vacuum-assisted breast biopsy: short-term effects, long-term effects and predictors. Health Qual Life Outcomes 2010; 8:11. [PMID: 20102642 PMCID: PMC2835677 DOI: 10.1186/1477-7525-8-11] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2009] [Accepted: 01/27/2010] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The impact of Vacuum-assisted breast biopsy (VABB, 11-Gauge) upon Health-related Quality of Life (HRQoL) remains an open field. This study aims to: i) assess short-term (4 days after VABB) responses in terms of HRQoL after VABB, ii) evaluate long-term (18 months after VABB) responses, if any, and iii) examine whether these responses are modified by a variety of possible predictors (anthropometric, sociodemographic, lifestyle habits, breast-related parameters, reproductive history, VABB-related features and complications, seasonality). METHODS This study included 102 eligible patients undergoing VABB and having benign lesions. A variable number of cores (24-96 cores) has been excised. HRQoL was assessed by EQ-5D and SF-36(R) questionnaires: i) in the morning of the VABB procedure day (baseline measurement), ii) four days after VABB (early post-biopsy measurement) and iii) 18 months after VABB (late post-biopsy measurement). Statistical analysis comprised two steps: i. evaluation of differences in EQ-5D/SF-36 dimensions and calculated scores (baseline versus early post-biopsy measurement and baseline versus late post-biopsy measurement) and ii. assessment of predictors through multivariate linear, logistic, ordinal logistic regression, as appropriate. RESULTS At baseline patients presented with considerable anxiety (EQ-5D anxiety/depression dimension, EQ-5D TTO/VAS indices, SF-36 Mental Health dimension). At the early post-biopsy measurement women exhibited deterioration in Usual Activities (EQ-5D) and Role Functioning-Physical dimensions. At the late measurement women exhibited pain (EQ-5D pain/discomfort and SF-36 Bodily Pain), deterioration in Physical Functioning (SF-36 PF) and overall SF-36 Physical Component Scale (PCS). Mastalgia, older age and lower income emerged as significant predictors for baseline anxiety, whereas seasonality modified early activities-related responses. Pain seemed idiosyncratic. CONCLUSIONS The HRQoL profile of patients suggests that VABB exerts effects prior to its performance at a psychological level, immediately after its performance at a functioning-physical level and entails long-term effects associated with pain.
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Affiliation(s)
- Philip J Domeyer
- Breast Unit, First Department of Propaedeutic Surgery, Hippokratio Hospital, Medical School, University of Athens, 108 Vas Sofias Ave, Athens 11527, Greece.
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Biopsy method: a major predictor of adherence after benign breast biopsy? AJR Am J Roentgenol 2009; 193:W452-7. [PMID: 19843727 DOI: 10.2214/ajr.08.1061] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Adopting a longitudinal approach to assess women after breast biopsy with a benign result, this study aimed to comparatively evaluate the effect of the biopsy method on compliance with clinical recommendations for follow-up. MATERIALS AND METHODS For this study, 410 patients who underwent biopsy of a breast lesion were included: fine-needle aspiration biopsy, n = 95 patients; core biopsy, n = 84; local excision under local anesthesia, n = 72; vacuum-assisted breast biopsy, n = 100; and hookwire localization, n = 59. Information about patient age, place of residence, whether complications occurred, and type of lesion was collected. RESULTS Compliance was higher among women who had undergone vacuum-assisted breast biopsy than those who had undergone one of the other biopsy methods. The superiority (carryover effect) of vacuum-assisted breast biopsy persisted for 18 months after the biopsy procedure. Patient compliance for all of the other biopsy methods followed an M pattern, with the peaks corresponding to the follow-up mammography sessions. In patients who had undergone vacuum-assisted breast biopsy, a gradual decrease in compliance over time was observed. Older women were more compliant than younger women with follow-up recommendations regardless of biopsy method. A subanalysis of the vacuum-assisted breast biopsy group indicated that complications are associated with better compliance. CONCLUSION Women more often adhere to clinical recommendations for follow-up sessions comprising mammography. Patient age and whether biopsy complications occurred also seem to modify compliance. Further studies should assess whether superior compliance after vacuum-assisted breast biopsy persists in other settings, such as with stereotactic or ultrasound guidance, different numbers of cores, and procedures of various durations.
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Zografos GC, Zagouri F, Sergentanis TN, Panou M, Dardamanis D, Giannakopoulou G, Filippakis GM, Papadimitriou G, Stamouli S. Psychiatric disorder associated with vacuum-assisted breast biopsy clip placement: a case report. J Med Case Rep 2008; 2:332. [PMID: 18928549 PMCID: PMC2579921 DOI: 10.1186/1752-1947-2-332] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2007] [Accepted: 10/17/2008] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Vacuum-assisted breast biopsy is a minimally invasive technique that has been used increasingly in the treatment of mammographically detected, non-palpable breast lesions. Clip placement at the biopsy site is standard practice after vacuum-assisted breast biopsy. CASE PRESENTATION We present the case of a 62-year-old woman with suspicious microcalcifications in her left breast. The patient was informed about vacuum-assisted breast biopsy, including clip placement. During the course of taking the patient's history, she communicated excellently, her demeanor was normal, she disclosed no intake of psychiatric medication and had not been diagnosed with any psychiatric disorders. Subsequently, the patient underwent vacuum-assisted breast biopsy (11 G) under local anesthesia. A clip was placed at the biopsy site. The pathological diagnosis was of sclerosing adenosis. At the 6-month mammographic follow-up, the radiologist mentioned the existence of the metallic clip in her breast. Subsequently, the woman presented complaining about "being spied [upon] by an implanted clip in [her] breast" and repeatedly requested the removal of the clip. The patient was referred to the specialized psychiatrist of our breast unit for evaluation. The Mental State Examination found that systematized paranoid ideas of persecutory type dominated her daily routines. At the time, she believed that the implanted clip was one of several pieces of equipment being used to keep her under surveillance, the other equipment being her telephone, cameras and television. Quite surprisingly, she had never had a consultation with a mental health professional. The patient appeared depressed and her insight into her condition was impaired. The prevalent diagnosis was schizotypal disorder, whereas the differential diagnosis comprised delusional disorder of persecutory type, affective disorder with psychotic features or comorbid delusional disorder with major depression. CONCLUSION This is the first report of a psychiatric disorder being brought to the fore using a vacuum-assisted breast biopsy clip. Vacuum-assisted breast biopsy, and breast biopsy in general, represent a significant experience, encompassing anxiety and pain; it may thus aggravate psychiatric conditions. Apart from these well-established factors, other aspects, such as the clip, may occasionally become significant. In a modern breast unit, the evaluation of patients should be multidisciplinary. A psychiatrist may be needed for optimal management of anxiety-related issues, as well as for the detection of psychiatric disorders.
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Affiliation(s)
- George C Zografos
- Breast Unit, Department of Propaedeutic Surgery, Hippokratio Hospital, School of Medicine, University of Athens, Vas Sofias Avenue, Athens, Greece.
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Zografos GC, Zagouri F, Sergentanis TN, Nonni A, Domeyer P, Koulocheri D, Flessas I, Panopoulou E, Chrysikos D, Bramis J. Pain during vacuum-assisted breast biopsy: are there any predictors? Breast 2008; 17:592-5. [PMID: 18657974 DOI: 10.1016/j.breast.2008.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2008] [Revised: 06/12/2008] [Accepted: 06/13/2008] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION To assess the putative predictors that may be implicated in the pain experienced during stereotactic vacuum-assisted breast biopsy (VABB). MATERIALS AND METHODS One hundred and thirty-five consecutive women with microcalcifications underwent VABB on the Fischer's table. The visual analogue scale was used to measure the degree of the "average pain" (AP). RESULTS At the univariable analysis, the AP was positively associated with the duration of the procedure, the diagnosis of malignant/preinvasive lesions and the volume of blood lost. Although menopausal status was not associated with the AP, within the premenopausal subpopulation, luteal phase was associated with higher VAS score. These findings also persisted at the multivariable ordinal logistic regression model. However, the mean experienced pain was associated neither with the volume of tissue excised nor with the hematoma formation, nor with patients' age. CONCLUSION The aforementioned factors were independent positive predictors of the mean experienced pain during VABB.
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Affiliation(s)
- George C Zografos
- Breast Unit, 1st Department of Propaedeutic Surgery, Hippokratio Hospital, University of Athens, 114 Vas Sofias Avenue, Athens 116 27, Greece.
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Zagouri F, Sergentanis TN, Koulocheri D, Giannakopoulou G, Nonni A, Dardamanis D, Michalopoulos NV, Flessas I, Bramis J, Zografos GC. Vacuum-assisted breast biopsy in close proximity to the skin: a case report. J Med Case Rep 2008; 2:165. [PMID: 18485241 PMCID: PMC2409353 DOI: 10.1186/1752-1947-2-165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2007] [Accepted: 05/18/2008] [Indexed: 11/10/2022] Open
Abstract
Introduction Vacuum-assisted breast biopsy is a minimally invasive technique used increasingly for the assessment of mammographically detected, non-palpable breast lesions. The effectiveness of vacuum-assisted breast biopsy has been demonstrated on lesions both with and without microcalcifications. Given that the position of the lesion represents a major factor in stereotactic vacuum-assisted breast biopsy, targeting lesions in close proximity to the skin (superficial lesions) has been described as a problematic issue. Case presentation A 53-year-old woman presented with a newly developed, non-palpable lesion in her left breast. The lesion consisted of widely spread microcalcifications located approximately 5 mm from the skin. The lesion was isoechoic on ultrasound examination. Vacuum-assisted breast biopsy was scheduled (on the Fischer's table, using 11-gauge probes, under local anaesthesia). The vacuum-assisted breast biopsy probe was inserted antidiametrically into the breast, the probe reached the lesion and effort was made to excise the microcalcifications. As only a small proportion of the microcalcifications were excised an accurate diagnosis could not be expected. However, with the probe having entered the breast antidiametrically, the probe tip underlying the skin could be palpated. Following the palpation of the tip, the exact point was marked by a pen, the probe was removed and the patient was transferred to the surgery room to have the remaining lesion removed by a spindle-form excision under local anaesthesia. The mammogram of the removed specimen confirmed the total excision of the suspicious microcalcifications. Conclusion Isoechoic superficial lesions can be localized with a hook-wire and open breast biopsy under general or local anaesthesia can be performed. However, vacuum-assisted breast biopsy might offer an alternative solution and serve as an alternative approach to localize the lesion. The clinical significance of the present exploratory effort remains to be assessed in the future.
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Affiliation(s)
- Flora Zagouri
- Breast Unit, 1st Department of Propaedeutic Surgery, Hippokratio Hospital, School of Medicine, University of Athens, Greece.
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