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Lescarbotte F, Romano G, Balleyguier C, Arfi Rouche J, Ilenko A, Leymarie N. [Extensive transfixing skin necrosis after breast biopsy under local anesthesia: About four cases]. ANN CHIR PLAST ESTH 2024; 69:27-33. [PMID: 37121845 DOI: 10.1016/j.anplas.2023.04.002] [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: 03/10/2023] [Revised: 04/03/2023] [Accepted: 04/13/2023] [Indexed: 05/02/2023]
Abstract
INTRODUCTION Local anesthetics with adrenaline are widely used in routine practice and have long proven their benefits and safety. The rare complications due to their use mainly concern immuno-allergic and vascular mechanisms. DESCRIPTION In this article, we present four similar cases of early transfixing skin necrosis occurring after radioguided breast biopsy under local anesthesia using epinephrine local anesthetics in the context of a diagnostic approach to breast cancer. DISCUSSION Although the literature is comforting about the use of local anesthetics, even on the extremities, severe skin complications continue to be reported sporadically. The analysis and understanding of these phenomena would allow, in the long run, to avoid them and to reduce their importance. CONCLUSION The occurrence of skin necrosis after breast biopsy under radiographic control is rare and seems to be related to the local anesthetic procedure. Although similar cases have been reported in the literature, it does not seem possible today to conclude on the exact physiopathology of these complications. A better knowledge of the pathophysiology of these complications would help to avoid their occurrence in the future.
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Affiliation(s)
- Francois Lescarbotte
- Department of Plastic and Breast Surgery, Gustave-Roussy Cancer Campus, Grand Paris, France.
| | - Golda Romano
- Department of Plastic and Breast Surgery, Gustave-Roussy Cancer Campus, Grand Paris, France
| | - Corinne Balleyguier
- Department of Medical Imagery, Gustave-Roussy Cancer Campus, Grand Paris, France
| | - Julia Arfi Rouche
- Department of Medical Imagery, Gustave-Roussy Cancer Campus, Grand Paris, France
| | - Anna Ilenko
- Department of Plastic and Breast Surgery, Gustave-Roussy Cancer Campus, Grand Paris, France
| | - Nicolas Leymarie
- Department of Plastic and Breast Surgery, Gustave-Roussy Cancer Campus, Grand Paris, France
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Wilcox Vanden Berg RN, George AK, Kaye DR. Should Transperineal Prostate Biopsy Be the Standard of Care? Curr Urol Rep 2023; 24:135-142. [PMID: 36512186 DOI: 10.1007/s11934-022-01139-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW We reviewed the advantages and disadvantages of transperineal prostate biopsy (TP-bx) to evaluate its potential role as the standard of care for prostate biopsy. RECENT FINDINGS Studies have suggested no difference in prostate cancer (PCa) detection rate between TP-bx and transrectal biopsy (TR-bx) but have suggested potentially increased detection of anterior prostate tumors. Advances in anesthetic technique have obviated the need for sedation thus allowing TP-bx to become an office-based procedure, which in turn can decrease the overall cost of TP-bx. Furthermore, given the low rate of infectious complications after TP-bx, some have foregone peri-procedural antibiotics without a change in the rate of infectious complications. Recent procedural advances have made TP-bx a tolerable, office-based procedure. Given the similar diagnostic performance and the benefits for the patient and community, TP-bx should become the standard of care for prostate biopsy for most patients. Future efforts should address the barriers for more universal adoption.
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Affiliation(s)
| | - Arvin K George
- Department of Urology, University of Michigan, Ann Arbor, MI, USA.,Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Deborah R Kaye
- Division of Urology, Department of Surgery, Duke University, Durham, NC, USA. .,Duke-Margolis Center for Public Policy, Duke University, Durham, NC, USA. .,Duke Clinical Research Institute, Durham, NC, USA. .,Duke Cancer Institute, Duke Cancer Center/Clinic 5-1, 20 Duke Medicine Circle Durham, Durham, NC, 27710, USA.
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Leitch J, Webb A, Pudwell J, Chamberlain S, Henry R, Nitsch R. Magnesium-based trigger point infiltrations versus local anesthetic infiltrations in chronic pelvic myofascial pain: A randomized, double-blind control study. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2022; 44:877-885. [PMID: 35339694 DOI: 10.1016/j.jogc.2022.02.129] [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: 08/17/2021] [Revised: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine if a novel, magnesium-based trigger point infiltration formulation is more effective in treating chronic myofascial pelvic pain than lidocaine-only infiltration. METHODS This was a single-centre, double-blind, randomized controlled trial of women diagnosed with chronic pelvic myofascial pain associated with trigger points. We compared a novel magnesium-based infiltration formulation with lidocaine infiltration of trigger points and with a control group of participants who were waitlisted for a chronic pain clinic. Treatment groups completed a 12-week program that included 8 trigger point injection treatments and nine visits during which pain scores were recorded and questionnaires administered. The primary outcome measure was change in mean pain score between baseline and the final visit. Secondary outcomes included pain with function scores, scores on the World Health Organization Quality of Life questionnaire, procedural pain, concomitant medication use, and complications. RESULTS We assigned 44 women diagnosed with chronic myofascial pelvic pain associated with trigger points to either the magnesium-based infiltrate (n = 15), lidocaine infiltrate (n = 17), or waitlist (n = 12) group. In the intent-to-treat analysis, a clinically relevant decrease in mean pain score out of 10 was observed in the magnesium-based (-2.6 ± 3.2) and lidocaine (-2.9 ± 3.1) infiltration groups, but not in the waitlist group (-0.5 ± 2.3). The per protocol analysis post-hoc tests, adjusted for multiple comparisons, found a significant difference in the average change in pain score between the magnesium-based infiltrate and the waitlist groups (P = 0.045), while differences between the lidocaine infiltrate and waitlist groups approached statistical significance (P = 0.052). Both treatment groups saw improvements in pain with function and quality of life scores. CONCLUSION While this study is underpowered, it does not support the use of a magnesium-based trigger point infiltrate in the treatment of chronic myofascial pelvic pain over lidocaine-only infiltration. Nonetheless, these results are consistent with current management recommendations and suggest improvements in pain, pain with function, and quality of life scores with either magnesium-based or lidocaine-only infiltration. We outline an approach to assessment and treatment that can be adopted by general gynaecologists.
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Affiliation(s)
- Jordan Leitch
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, ON
| | - Amanda Webb
- Department of Obstetrics and Gynecology, Queen's University, Kingston, ON
| | - Jessica Pudwell
- Department of Obstetrics and Gynecology, Queen's University, Kingston, ON
| | - Susan Chamberlain
- Department of Obstetrics and Gynecology, Queen's University, Kingston, ON
| | - Richard Henry
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, ON
| | - Romy Nitsch
- Department of Obstetrics and Gynecology, Queen's University, Kingston, ON.
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Haddad EM, El Khoury M, Labelle M, Trop I, Karam E, Mesurolle B. Anesthésie locale et biopsies mammaires : comment les optimiser en réduisant la douleur et les complications. IMAGERIE DE LA FEMME 2022. [DOI: 10.1016/j.femme.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Simmons CL, Harper LK, Holst KJ, Brinkman NJ, Lee CU. Bargain Hunting for Buffered Lidocaine: A Collaborative Discovery of Cost-saving Strategies That Can Improve Patient Care. JOURNAL OF BREAST IMAGING 2021; 3:93-97. [PMID: 38424833 DOI: 10.1093/jbi/wbaa077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 07/26/2020] [Indexed: 03/02/2024]
Abstract
Buffered lidocaine is a local anesthetic option during percutaneous needle-directed procedures in the breast. At our institution, sodium bicarbonate (the buffer) is dispensed in volumes that frequently lead to medical waste and shortages. In this study, we describe how moving the buffering of lidocaine from the procedure room to our clinical hospital pharmacy results in a reduction in costs and improves satisfaction across the breast radiology department. While cost savings are difficult to tease out in practices that opt for bundled payments, we were able to access pricing and supply data and coordinate with our pharmacy to change our practice. Making these changes saves our practice $26 000 a year and allows us to continue to offer buffered lidocaine even during sodium bicarbonate shortages. This manuscript describes how these changes came about and their economic impact.
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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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Bhatt AA, Woodard GA, Lee CU. Hydrodissection - Practical applications in ultrasound-guided breast interventions. Clin Imaging 2020; 72:198-203. [PMID: 33486301 DOI: 10.1016/j.clinimag.2020.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/19/2020] [Accepted: 11/02/2020] [Indexed: 11/25/2022]
Abstract
Hydrodissection is a procedural tactic utilized in various interventions. It is a technique which helps separate structures in order to safely perform a certain procedure. This article will provide a review of hydrodissection, how to perform this technique, and why it can be useful in breast interventions.
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Affiliation(s)
- Asha A Bhatt
- Mayo Clinic, Department of Radiology - Division of Breast Imaging, 200 1(st) Street SW, Rochester, MN 55905, United States of America.
| | - Genevieve A Woodard
- Mayo Clinic, Department of Radiology - Division of Breast Imaging, 200 1(st) Street SW, Rochester, MN 55905, United States of America
| | - Christine U Lee
- Mayo Clinic, Department of Radiology - Division of Breast Imaging, 200 1(st) Street SW, Rochester, MN 55905, United States of America
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Van Denburg AN, Shelby RA, Winger JG, Zhang L, Soo AE, Pearce MJ, Soo MS. Unmet Spiritual Care Needs in Women Undergoing Core Needle Breast Biopsy. JOURNAL OF BREAST IMAGING 2020; 2:134-140. [PMID: 38424885 DOI: 10.1093/jbi/wbz089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Indexed: 03/02/2024]
Abstract
OBJECTIVE Spiritual care is an important part of healthcare, especially when patients face a possible diagnosis of a life-threatening disease. This study examined the extent to which women undergoing core-needle breast biopsy desired spiritual support and the degree to which women received the support they desired. METHODS Participants (N = 79) were women age 21 and older, who completed an ultrasound- or stereotactic-guided core-needle breast biopsy. Participants completed measures of spiritual needs and spiritual care. Medical and sociodemographic information were also collected. Independent sample t-tests and chi-square tests of examined differences based on demographic, medical, and biopsy-related variables. RESULTS Forty-eight participants (48/79; 60.8%) desired some degree of spiritual care during their breast biopsy, and 33 participants (33/78; 42.3%) wanted their healthcare team to address their spiritual needs. African American women were significantly more likely to desire some type of spiritual support compared to women who were not African American. Among the 79 participants, 16 (20.3%) reported a discrepancy between desired and received spiritual support. A significant association between discrepancies and biopsy results was found, χ 2(1) = 4.19, P = .04, such that 2 (7.4%) of 27 participants with results requiring surgery reported discrepancies, while 14 (26.9%) of 52 participants with a benign result reported discrepancies. CONCLUSION Most women undergoing core-needle breast biopsy desired some degree of spiritual care. Although most reported that their spiritual needs were addressed, a subset of women received less care than desired. Our results suggest that healthcare providers should be aware of patients' desires for spiritual support, particularly among those with benign results.
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Affiliation(s)
- Alyssa N Van Denburg
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, NC
| | - Rebecca A Shelby
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, NC
| | - Joseph G Winger
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, NC
| | - Lei Zhang
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, NC
| | - Adrianne E Soo
- Medical University of South Carolina College of Medicine, Department of Emergency Medicine, Charleston, SC
| | - Michelle J Pearce
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, NC
- University of Maryland, Baltimore, Center for Integrative Medicine, Baltimore, MD
| | - Mary Scott Soo
- Duke University School of Medicine, Department of Radiology, Durham, NC
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Soo MS, Shelby RA, Johnson KS. Optimizing the Patient Experience during Breast Biopsy. JOURNAL OF BREAST IMAGING 2019; 1:131-138. [PMID: 38424912 DOI: 10.1093/jbi/wbz001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Indexed: 03/02/2024]
Abstract
For years, breast imaging has been the model in radiology for patient communication, and more recently, it has been a leader in the growing patient- and family-centered approach to care. To maintain high levels of patient satisfaction during image-guided core-needle breast biopsies, the radiologist should understand patient perspectives so that interventions can be developed to manage patient concerns. This article reviews patient perspectives before, during, and after imaging-guided breast biopsies, and it describes strategies to help optimize the experiences of patients as they navigate the process.
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Affiliation(s)
- Mary Scott Soo
- Duke University Medical Center, Department of Radiology, Durham, NC
| | - Rebecca A Shelby
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, NC
| | - Karen S Johnson
- Duke University Medical Center, Department of Radiology, Durham, NC
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