1
|
Zhang Y, Li J, Mo M, Shen J, Ren H, Li S, Liu G, Shao Z. The comparison of efficacy and safety evaluation of vacuum-assisted Elite 10-G system and the traditional BARD 14-G core needle in breast diagnosis: an open-label, parallel, randomized controlled trial. Int J Surg 2023; 109:1180-1187. [PMID: 37042316 PMCID: PMC10389332 DOI: 10.1097/js9.0000000000000257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 01/26/2023] [Indexed: 04/13/2023]
Abstract
BACKGROUND Vacuum-assisted biopsy (VAB) and core needle biopsy (CNB) are both widely used methods in diagnosing breast lesions. We aimed to determine whether the Elite 10-gauge VAB achieves higher accuracy than the BARD spring-actuated 14-gauge CNB. MATERIALS AND METHODS This was a phase 3, open-label, parallel, randomized controlled trial (NCT04612439). In total, 1470 patients with ultrasound (US)-visible breast lesions requiring breast biopsy were enrolled from April to July 2021 and randomized at a 1 : 1 ratio to undergo VAB or CNB. All patients underwent surgical excision after needle biopsy. The primary outcome was accuracy, defined as the proportion of patients who had a consistent qualitative diagnosis between the biopsy and surgical pathology results. The underestimation rate, false-negative rate and safety evaluations were the secondary endpoints. RESULTS A total of 730 and 732 patients were evaluable for endpoints in the VAB and CNB groups, respectively. The accuracy of VAB surpassed that of CNB in the whole population (94.8 vs. 91.1%, P =0.009). The overall malignant underestimation rate was significantly lower in the VAB group than in the CNB group (21.4 vs. 30.9%, P =0.035). Additionally, significantly more false-negative events were noted in the CNB group (4.9 vs. 7.8%, P =0.037). In patients who presented with accompanying calcification, the accuracy of VAB surpassed that of CNB (93.2 vs. 88.3%, P =0.022). The potential superiority of VAB was indicated in patients with heterogeneous echo on US. CONCLUSIONS In general, the 10-G VAB procedure is a reasonable alternative to the 14-G CNB procedure with higher accuracy. We recommend the use of VAB for lesions with accompanying calcification or heterogeneous echo on US.
Collapse
Affiliation(s)
- Ying Zhang
- Department of Breast Surgery
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| | - Junjie Li
- Department of Breast Surgery
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| | - Miao Mo
- Clinical Statistics Center, Fudan University Shanghai Cancer Center
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| | - Juping Shen
- Department of Breast Surgery
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| | - Hui Ren
- Department of Breast Surgery
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| | - Shiping Li
- Department of Breast Surgery
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| | - Guangyu Liu
- Department of Breast Surgery
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| | - Zhimin Shao
- Department of Breast Surgery
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| |
Collapse
|
2
|
Sharma D, Carter H, Sannachi L, Cui W, Giles A, Saifuddin M, Czarnota GJ. Quantitative Ultrasound for Evaluation of Tumour Response to Ultrasound-Microbubbles and Hyperthermia. Technol Cancer Res Treat 2023; 22:15330338231200993. [PMID: 37750232 PMCID: PMC10521270 DOI: 10.1177/15330338231200993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023] Open
Abstract
Objectives: Prior study has demonstrated the implementation of quantitative ultrasound (QUS) for determining the therapy response in breast tumour patients. Several QUS parameters quantified from the tumour region showed a significant correlation with the patient's clinical and pathological response. In this study, we aim to identify if there exists such a link between QUS parameters and changes in tumour morphology due to combined ultrasound-stimulated microbubbles (USMB) and hyperthermia (HT) using the breast xenograft model (MDA-MB-231). Method: Tumours grown in the hind leg of severe combined immuno-deficient mice were treated with permutations of USMB and HT. Ultrasound radiofrequency data were collected using a 25 MHz array transducer, from breast tumour-bearing mice prior and post-24-hour treatment. Result: Our result demonstrated an increase in the QUS parameters the mid-band fit and spectral 0-MHz intercept with an increase in HT duration combined with USMB which was found to be reflective of tissue structural changes and cell death detected using haematoxylin and eosin and terminal deoxynucleotidyl transferase dUTP nick end labelling stain. A significant decrease in QUS spectral parameters was observed at an HT duration of 60 minutes, which is possibly due to loss of nuclei by the majority of cells as confirmed using histology analysis. Morphological alterations within the tumour might have contributed to the decrease in backscatter parameters. Conclusion: The work here uses the QUS technique to assess the efficacy of cancer therapy and demonstrates that the changes in ultrasound backscatters mirrored changes in tissue morphology.
Collapse
Affiliation(s)
- Deepa Sharma
- Imaging Research and Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Departments of Medical Biophysics and Radiation Oncology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Holliday Carter
- Imaging Research and Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Lakshmanan Sannachi
- Imaging Research and Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Departments of Medical Biophysics and Radiation Oncology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Wentao Cui
- Imaging Research and Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Anoja Giles
- Imaging Research and Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Murtuza Saifuddin
- Imaging Research and Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Gregory J. Czarnota
- Imaging Research and Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Departments of Medical Biophysics and Radiation Oncology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
3
|
Soliman AH. Ultrasound-guided vacuum-assisted excision biopsy in breast fibroadenomas: an Egyptian center experience. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00874-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Benign breast tumors although classified as benign lesions but excising them remain a troublesome problem. Surgical excision for benign breast lesions frightens most of female population suffering from such a problem, which created an urgency to search for a safe and effective alternative. My aim was to assess the efficacy of vacuum-assisted biopsy (VAB) excision system for the removal of benign breast lesions in terms of complete excision rate and incidence of complications.
Results
Twenty-three female patients with 29 twenty-nine lesions were included in our study. Mean age was 33 years (19–52 years). The incidence of complete excision was 100% in follow-up with 3 drop outs. The largest diameter of the tumors ranged from 1.2 to 3.3 cm. Rate of occurrence of complications in form of intra-procedural pain, 69% of our patients experienced mild intra-procedural pain with visual analog pain scale (VAS) score (1–3).21% experienced moderate pain with VAS score (4–6).8% experienced no pain. Patients who developed post procedural ecchymosis were 17% while hematoma group of patients were 10% of total number of patients.
Conclusions
The study showed that the use of vacuum-assisted biopsy excision system could provide a safe method for complete excision of fibroadenomas, with low rate of complications as incomplete excision, pain, and hematoma formation.
Collapse
|
4
|
Nakano S, Imawari Y, Mibu A, Otsuka M, Oinuma T. Differentiating vacuum-assisted breast biopsy from core needle biopsy: Is it necessary? Br J Radiol 2018; 91:20180250. [PMID: 29975150 DOI: 10.1259/bjr.20180250] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Needle biopsy has replaced excisional biopsy as a definitive diagnostic technique for breast tumours, although excisional biopsy is still used for complete tumour removal for therapeutic and/or diagnostic purposes. Many vacuum-assisted breast biopsy (VAB) systems have been made available by several manufacturers since the release of the Mammotome (MMT) by Johnson & Johnson in 1995. Several recent discussions have been conducted to identify whether core needle biopsy (CNB) or VAB, is more appropriate. However, currently available VAB systems differ from the conventional system (i.e. articulate arm type 11-gauge(G) MMT), and the characteristics of both CNB and VAB have been improved. In CNB, a 14-G needle is frequently used to obtain a larger sample. By contrast, VAB is considered easier to perform because it uses a thinner needle and a lighter, non-tethered system. When differentiating CNB from VAB, the type of VAB should also be defined. In this review, we discuss the characteristics of ultrasonography-guided VAB and CNB with a focus on practical issues such as the number of samples and volume of tissue obtained during ultrasonography-guided needle biopsy.
Collapse
Affiliation(s)
- Satoko Nakano
- 1 Department of Breast Surgery, Kawaguchi Municipal Medical Center , Kawaguchi , Japan
| | - Yoshimi Imawari
- 1 Department of Breast Surgery, Kawaguchi Municipal Medical Center , Kawaguchi , Japan
| | - Akemi Mibu
- 1 Department of Breast Surgery, Kawaguchi Municipal Medical Center , Kawaguchi , Japan
| | - Masahiko Otsuka
- 2 Department of Surgery, Kawaguchi Municipal Medical Center , Kawaguchi , Japan
| | - Toshinori Oinuma
- 3 Department of Pathology, Kawaguchi Municipal Medical Center , Kawaguchi , Japan
| |
Collapse
|
5
|
Abstract
Pain has been identified as one of the most significant factors in patients' experience of cancer and its treatment. Pain experienced during cancer treatment procedures such as radiotherapy can be unpleasant and distressing for the patient, as well as for their family and carers. Nurses have an important role in assessing and managing any pain associated with such procedures. This article explores the procedural pain that may be experienced by patients in general, and by those with cancer specifically, and details the pharmacological and non-pharmacological strategies that nurses can use to manage this challenging complication.
Collapse
Affiliation(s)
- Eamon McMonagle
- Pain Service, Imperial College Healthcare NHS Trust, London, England
| |
Collapse
|
6
|
Huang XC, Hu XH, Wang XR, Zhou CX, Wang FF, Yang S, Wang GY. A comparison of diagnostic performance of vacuum-assisted biopsy and core needle biopsy for breast microcalcification: a systematic review and meta-analysis. Ir J Med Sci 2018; 187:999-1008. [DOI: 10.1007/s11845-018-1781-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 03/01/2018] [Indexed: 01/26/2023]
|
7
|
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.
Collapse
|
8
|
Papathemelis T, Heim S, Lux MP, Erhardt I, Scharl A, Scharl S. Minimally Invasive Breast Fibroadenoma Excision Using an Ultrasound-Guided Vacuum-Assisted Biopsy Device. Geburtshilfe Frauenheilkd 2017; 77:176-181. [PMID: 28331240 DOI: 10.1055/s-0043-100387] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Introduction We studied the extent to which an ultrasound-guided vacuum-assisted biopsy device ("hand-held Mammotome") could be used not only as a valuable tool for investigation of suspicious breast lesions, but also therapeutically for the complete removal of breast fibroadenomas. Materials and Methods 132 aspiration biopsies showing fibroadenoma on histology were collected retrospectively. We ascertained whether there were residual findings on breast ultrasound at a median follow-up of approx. 9 months following biopsy. A questionnaire was used to determine the complication rate, patient satisfaction and acceptance of the procedure. Results In this study complete fibroadenomectomy was achieved at aspiration biopsy in 76 % of cases (n = 132). Compared to fibroadenomas larger than 2.51 cm3 (59 %), those smaller than 2.5 cm3 were completely removed more often (87.6 %; p < 0.05). The procedure is associated with very little pain during and after biopsy and minimal haematoma development, both factors supporting a high rate of acceptance among patients. Conclusion Ultrasound-guided vacuum-assisted biopsy is safe and associated with very few complications. Its additional therapeutic potential is dependant on the size of the benign lesion as measured at initial ultrasound.
Collapse
Affiliation(s)
| | | | - Michael P Lux
- Universitätsfrauenklinik Erlangen, Erlangen, Germany
| | | | | | - Sophia Scharl
- Klinik für Strahlentherapie, Universität Regensburg, Regensburg, Germany
| |
Collapse
|
9
|
Maxwell AJ, Bundred NJ, Harvey J, Hunt R, Morris J, Lim YY. A randomised pilot study comparing 13 G vacuum-assisted biopsy and conventional 14 G core needle biopsy of axillary lymph nodes in women with breast cancer. Clin Radiol 2016; 71:551-7. [PMID: 27040801 DOI: 10.1016/j.crad.2016.02.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 02/04/2016] [Accepted: 02/26/2016] [Indexed: 12/11/2022]
Abstract
AIM To compare the acceptability, safety, and feasibility of vacuum-assisted biopsy (VAB) and core needle biopsy (CNB) of axillary lymph nodes in women with breast cancer. MATERIALS AND METHODS This parallel, non-blinded, randomised study was approved by the National Research Ethics Service. Following written informed consent, women with abnormal appearing axillary lymph nodes and radiologically malignant breast masses were randomised 1:1 to lymph node sampling under local anaesthetic with either 14 G CNB or 13 G VAB in a single UK centre. Primary outcomes were study uptake rate and patient willingness to undergo a repeat procedure if necessary. Procedure duration, immediate and post-procedure pain scores, diagnostic yield, complications, and surgical histopathology were recorded. RESULTS Ninety-five women were approached; 81 (85.3%) consented and were randomised. Forty underwent CNB; 40 underwent VAB; one was excluded. Median age was 57 years. The median procedure time was 2 minutes for both techniques. The median number of samples obtained was three for CNB and four for VAB. Median pain scores for the procedure and first 3 days were 1/10 and 1/10 for CNB and 1/10 and 2/10 for VAB (p=0.11 and 0.04). More women were prepared to undergo repeat CNB compared to VAB, but the difference was not significant (38/39 versus 33/39; p=0.11). Two patients developed a haematoma after VAB. One CNB and six VABs failed to yield adequate tissue (p=0.11), but the sensitivity was similar at 79% and 78%. CONCLUSION Study uptake was high. Acceptability of the two procedures was similar, but VAB was associated with more post-procedure pain. The sensitivity appears to be similar.
Collapse
Affiliation(s)
- A J Maxwell
- Nightingale Centre and Genesis Prevention Centre, University Hospital of South Manchester, Southmoor Road, Manchester M23 9LT, UK; Centre for Imaging Sciences, Institute of Population Health, University of Manchester, Oxford Road, Manchester M13 9PT, UK.
| | - N J Bundred
- Nightingale Centre and Genesis Prevention Centre, University Hospital of South Manchester, Southmoor Road, Manchester M23 9LT, UK; Institute of Cancer Sciences, University of Manchester, Manchester Cancer Research Centre, Wilmslow Road, Manchester M20 4QL, UK
| | - J Harvey
- Nightingale Centre and Genesis Prevention Centre, University Hospital of South Manchester, Southmoor Road, Manchester M23 9LT, UK
| | - R Hunt
- Department of Histopathology, University Hospital of South Manchester, Southmoor Road, Manchester M23 9LT, UK
| | - J Morris
- Medical Statistics Department, Education and Research Centre, University Hospital of South Manchester, Southmoor Road, Manchester M23 9LT, UK; Centre for Biostatistics, Institute of Population Health, University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Y Y Lim
- Nightingale Centre and Genesis Prevention Centre, University Hospital of South Manchester, Southmoor Road, Manchester M23 9LT, UK; Centre for Imaging Sciences, Institute of Population Health, University of Manchester, Oxford Road, Manchester M13 9PT, UK
| |
Collapse
|
10
|
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.
| |
Collapse
|
11
|
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.
Collapse
|
12
|
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.
Collapse
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.
| |
Collapse
|
13
|
Significance of Fine Needle Aspiration Cytology and Vacuum-Assisted Core Needle Biopsy for Small Breast Lesions. Clin Breast Cancer 2015; 15:e23-6. [DOI: 10.1016/j.clbc.2014.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 07/09/2014] [Indexed: 11/27/2022]
|
14
|
Freeman GA, Kimmelman J. Publication and reporting conduct for pharmacodynamic analyses of tumor tissue in early-phase oncology trials. Clin Cancer Res 2012; 18:6478-84. [PMID: 22912391 DOI: 10.1158/1078-0432.ccr-12-1384] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE In principle, nondiagnostic biopsies for pharmacodynamic (PD) studies are carried out to inform decision-making in drug development. Because such procedures have no therapeutic value, their ethical justification requires that results be published. We aimed to assess the frequency of nonpublication of PD data in early phase cancer trials and to identify factors that prevent full publication of data. METHODS We identified a sample of early-phase cancer trials containing invasive nondiagnostic tissue procurement for PD analysis from American Society of Clinical Oncology and American Association for Cancer Research meeting abstracts published between 1995 and 2005. These trials were followed to publication to determine frequency of nonpublication of PD data. Corresponding authors on early-phase cancer trials using invasive nondiagnostic research procedures were also surveyed to identify factors preventing full publication of PD data. RESULTS In a sample of 90 trials, 22.2% (20 trials) resulted in no trial publication. Of published trials expected to contain PD reports, 16 (17.8%) did not include any PD data, and 21 (23.3%) reported incomplete PD data. We surveyed 92 authors; nonpublication was regarded as a frequent occurrence, and the most commonly cited barrier to full publication of PD data was strategic considerations in publication (58.8% of responding authors). CONCLUSIONS Our results suggest ways that investigators, study planners, and reviewers can improve the burden/knowledge value balance in PD studies.
Collapse
Affiliation(s)
- Georgina A Freeman
- Biomedical Ethics Unit, Department of Experimental Medicine, Department of Social Studies of Medicine, McGill University, Montreal, Quebec, Canada
| | | |
Collapse
|
15
|
Povoski SP, Jimenez RE, Wang WP. Ultrasound-guided diagnostic breast biopsy methodology: retrospective comparison of the 8-gauge vacuum-assisted biopsy approach versus the spring-loaded 14-gauge core biopsy approach. World J Surg Oncol 2011; 9:87. [PMID: 21835024 PMCID: PMC3171710 DOI: 10.1186/1477-7819-9-87] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Accepted: 08/11/2011] [Indexed: 11/12/2022] Open
Abstract
Background Ultrasound-guided diagnostic breast biopsy technology represents the current standard of care for the evaluation of indeterminate and suspicious lesions seen on diagnostic breast ultrasound. Yet, there remains much debate as to which particular method of ultrasound-guided diagnostic breast biopsy provides the most accurate and optimal diagnostic information. The aim of the current study was to compare and contrast the 8-gauge vacuum-assisted biopsy approach and the spring-loaded 14-gauge core biopsy approach. Methods A retrospective analysis was done of all ultrasound-guided diagnostic breast biopsy procedures performed by either the 8-gauge vacuum-assisted biopsy approach or the spring-loaded 14-gauge core biopsy approach by a single surgeon from July 2001 through June 2009. Results Among 1443 ultrasound-guided diagnostic breast biopsy procedures performed, 724 (50.2%) were by the 8-gauge vacuum-assisted biopsy technique and 719 (49.8%) were by the spring-loaded 14-gauge core biopsy technique. The total number of false negative cases (i.e., benign findings instead of invasive breast carcinoma) was significantly greater (P = 0.008) in the spring-loaded 14-gauge core biopsy group (8/681, 1.2%) as compared to in the 8-gauge vacuum-assisted biopsy group (0/652, 0%), with an overall false negative rate of 2.1% (8/386) for the spring-loaded 14-gauge core biopsy group as compared to 0% (0/148) for the 8-gauge vacuum-assisted biopsy group. Significantly more (P < 0.001) patients in the spring-loaded 14-gauge core biopsy group (81/719, 11.3%) than in the 8-gauge vacuum-assisted biopsy group (18/724, 2.5%) were recommended for further diagnostic surgical removal of additional tissue from the same anatomical site of the affected breast in an immediate fashion for indeterminate/inconclusive findings seen on the original ultrasound-guided diagnostic breast biopsy procedure. Significantly more (P < 0.001) patients in the spring-loaded 14-gauge core biopsy group (54/719, 7.5%) than in the 8-gauge vacuum-assisted biopsy group (9/724, 1.2%) personally requested further diagnostic surgical removal of additional tissue from the same anatomical site of the affected breast in an immediate fashion for a benign finding seen on the original ultrasound-guided diagnostic breast biopsy procedure. Conclusions In appropriately selected cases, the 8-gauge vacuum-assisted biopsy approach appears to be advantageous to the spring-loaded 14-gauge core biopsy approach for providing the most accurate and optimal diagnostic information.
Collapse
Affiliation(s)
- Stephen P Povoski
- Division of Surgical Oncology, Department of Surgery, Arthur G, James Cancer Hospital and Richard J, Solove Research Institute and Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio 43210, USA.
| | | | | |
Collapse
|