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Hu Y, Mei J, Yang Y, Gu R, Zhong J, Jiang X, Liu F, Yong J, Wang H, Shen S, Liang J, Liu Q, Gong C. Specimen number based diagnostic yields of suspicious axillary lymph nodes in core biopsy in breast cancer: clinical implications from a prospective exploratory study. Quant Imaging Med Surg 2021; 11:2151-2161. [PMID: 33936995 DOI: 10.21037/qims-20-1030] [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: 11/06/2022]
Abstract
Background Ultrasound (US)-guided core needle biopsy (CNB) is widely applied in the pathological diagnosis of suspicious axillary lymph nodes (ALNs) in breast cancer. However, the number of specimens removed during biopsy is currently based on the preference of the individual radiologist. This study aims to analyze the specimen number based diagnostic yields of US guided CNB of suspicious ALNs in breast cancer. Methods Core biopsy specimens of suspicious lymph nodes were prospectively obtained from breast cancer patients treated at our hospital between November, 2018, and July, 2019. Four specimens were obtained from each patient and labeled 1-4 in the order they were removed. Each specimen underwent pathological evaluation to determine whether metastasis had occurred. The diagnostic yields of the specimens were calculated and differences in diagnostic accuracy according to the number of specimens were evaluated by McNemar's test. Results A total of 167 patients were enrolled, and 139 (83.2%) cases were identified as metastasis by CNB. The diagnostic yields were: 74.2% (specimen 1), 87.8% (specimens 1-2), 91.2% (specimens 1-3), and 94.6% (specimens 1-4). The increases in diagnostic yield from specimen 1 to 1-2 and from specimens 1-2 to 1-4 were significant; however, no significant differences were detected between specimens 1-3 and the first two, or between specimens 1-4 and the first three in this sample size. The lower diagnostic abilities for the first two specimens were associated with shorter long- and short-axis lengths of lymph nodes on US. Conclusions Although the second specimen contributed significant diagnostic yield of suspicious axillary lymph nodes in core biopsy in breast cancer, a minimum number cannot be determined by this study. Additional specimens may improve diagnostic yield particularly in patients with small nodes.
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Affiliation(s)
- Yue Hu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jingsi Mei
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yaping Yang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ran Gu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jiajie Zhong
- Department of Pathology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaofang Jiang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Fengtao Liu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Juanjuan Yong
- Department of Pathology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hongli Wang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shiyu Shen
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jing Liang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qiang Liu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chang Gong
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Bioland Laboratory (Guangzhou Regenerative Medicine and Health Guangdong Laboratory), Guangzhou, China
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Schässburger KU, Paepke S, Saracco A, Azavedo E, Ekström C, Wiksell H. High velocity pulse biopsy device enables controllable and precise needle insertion and high yield tissue acquisition. Phys Med 2018. [DOI: 10.1016/j.ejmp.2017.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Vieira SL, Pavan TZ, Junior JE, Carneiro AAO. Paraffin-gel tissue-mimicking material for ultrasound-guided needle biopsy phantom. ULTRASOUND IN MEDICINE & BIOLOGY 2013; 39:2477-84. [PMID: 24035622 DOI: 10.1016/j.ultrasmedbio.2013.06.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 06/11/2013] [Accepted: 06/12/2013] [Indexed: 05/08/2023]
Abstract
Paraffin-gel waxes have been investigated as new soft tissue-mimicking materials for ultrasound-guided breast biopsy training. Breast phantoms were produced with a broad range of acoustical properties. The speed of sound for the phantoms ranged from 1425.4 ± 0.6 to 1480.3 ± 1.7 m/s at room temperature. The attenuation coefficients were easily controlled between 0.32 ± 0.27 dB/cm and 2.04 ± 0.65 dB/cm at 7.5 MHz, depending on the amount of carnauba wax added to the base material. The materials do not suffer dehydration and provide adequate needle penetration, with a Young's storage modulus varying between 14.7 ± 0.2 kPa and 34.9 ± 0.3 kPa. The phantom background material possesses long-term stability and can be employed in a supine position without changes in geometry. These results indicate that paraffin-gel waxes may be promising materials for training radiologists in ultrasound biopsy procedures.
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Affiliation(s)
- Sílvio L Vieira
- Instituto de Física, Universidade Federal de Goiás, Goiânia, GO, Brazil.
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4
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Abstract
Ultrasonography (US) is an indispensable tool in breast imaging and is complementary to both mammography and magnetic resonance (MR) imaging of the breast. Advances in US technology allow confident characterization of not only benign cysts but also benign and malignant solid masses. Knowledge and understanding of current and emerging US technology, along with the application of meticulous scanning technique, is imperative for image optimization and diagnosis. The ability to synthesize breast US findings with multiple imaging modalities and clinical information is also necessary to ensure the best patient care. US is routinely used to guide breast biopsies and is also emerging as a supplemental screening tool in women with dense breasts and a negative mammogram. This review provides a summary of current state-of-the-art US technology, including elastography, and applications of US in clinical practice as an adjuvant technique to mammography, MR imaging, and the clinical breast examination. The use of breast US for screening, preoperative staging for breast cancer, and breast intervention will also be discussed.
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Affiliation(s)
- Regina J Hooley
- Department of Diagnostic Radiology, Yale University School of Medicine, 333 Cedar St, PO Box 208042, New Haven, CT 06520-8042, USA.
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Rouse HC, Ussher S, Kavanagh AM, Cawson JN. Examining the sensitivity of ultrasound-guided large core biopsy for invasive breast carcinoma in a population screening programme. J Med Imaging Radiat Oncol 2013; 57:435-43. [PMID: 23870339 DOI: 10.1111/1754-9485.12050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 12/20/2013] [Indexed: 10/27/2022]
Abstract
INTRODUCTION To evaluate the sensitivity of ultrasound-guided core-needle biopsy (UCB) in invasive breast carcinoma and to establish causes of false-negative biopsy in a population screening programme. METHOD We identified 571 consecutive women diagnosed with surgically proven invasive breast cancer. Histology from 14-gauge UCB was compared with surgical histology to identify true-positive and false-negative ultrasound core biopsies. True-positive and false-negative groups were compared for tumour size and histology. On blinded review of UCB images and pathology reports from false negative (n = 20) and a random sample of true-positive cases (n = 80), we compared core sample number and needle visualisation in the lesion. RESULTS Of 571 carcinomas sampled with UCB, 551 (96.5%) were true positive and 20 (3.5%) were false negative. The mean core number was 2.0 (range 1-3) for false negatives and 2.25 (range 1-4) for true positives (P = 0.27). Mean tumour sizes were 13.3 and 16.2 mm for the false-negative and true-positive groups, respectively (P = 0.25). Tubular carcinomas represented 30% (6/20) of false-negative cases compared with 5.1% (28/551) of the true-positive cases (P < 0.001). On blinded review, needle visualisation within the lesion was demonstrated in 47.4% (9/19) of false-negative cases and 76.3% (61/80) of true-positive cases (P = 0.02). CONCLUSION We demonstrated a sensitivity of 96.5% with a mean of 2.21 cores. False-negative results were more likely in the absence of post-fire needle position verification and with tubular carcinomas. Neither tumour size nor core number predicted diagnostic accuracy.
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Affiliation(s)
- Hannah C Rouse
- St Vincent's Breast Screen, St Vincent's Hospital Campus
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Kasprowicz N, Bauerschmitz GJ, Schönherr A, Baldus SE, Janni W, Mohrmann S. Recurrent Mastitis after Core Needle Biopsy: Case Report of an Unusual Complication after Core Needle Biopsy of a Phyllodes Tumor. Breast Care (Basel) 2012; 7:240-244. [PMID: 22872800 DOI: 10.1159/000339689] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND: In the routine work-up of suspect breast lesions, ultrasound-controlled core needle biopsy (CNB) is the most common tool to acquire tissue for histopathologic analysis in a safe, quick and convenient way. Complications are generally rare. The most common complications are hematoma and infection, each with less than 1 in 1000 cases. CASE REPORT: Here, we present a case of a 48-year-old patient who underwent CNB for several lesions that were assessed as Breast Imaging Report and Data System (BI-RADS) IV in breast ultrasound and mammography. In the past, she had had 2 bilateral breast reduction surgeries and 1 open biopsy of a fibroadenoma. Histology revealed a phyllodes tumor. Following this, mastitis occurred which was resistant to common conservative measurements such as intravenous antibiotics over months. Finally, mastectomy was performed, followed by adequate wound healing. CONCLUSIONS: In the presented case, the prolonged course of breast infection after CNB was not as expected. If this occurs, conservative treatment with antibiotics can be initiated. Possible additional risk factors such as diabetes mellitus, steroid therapy, or immunosuppression should be identified. However, in case of missing recovery, wide surgical excision is recommended.
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Affiliation(s)
- Nikola Kasprowicz
- Breast Center, Department of Gynecology and Obstetrics, Düsseldorf University Hospital, Germany
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Kirshenbaum K, Keppke A, Hou K, Dickerson M, Gajjar M, Kirshenbaum G. Reassessing Specimen Number and Diagnostic Yield of Ultrasound Guided Breast Core Biopsy. Breast J 2012; 18:464-9. [DOI: 10.1111/j.1524-4741.2012.01269.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Uematsu T. How to choose needles and probes for ultrasonographically guided percutaneous breast biopsy: a systematic approach. Breast Cancer 2012; 19:238-41. [DOI: 10.1007/s12282-012-0340-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Accepted: 01/15/2012] [Indexed: 11/24/2022]
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Kim MJ, Kim JY, Yoon JH, Youk JH, Moon HJ, Son EJ, Kwak JY, Kim EK. How to Find an Isoechoic Lesion with Breast US. Radiographics 2011; 31:663-76. [DOI: 10.1148/rg.313105038] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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10
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False-negative ultrasound-guided vacuum-assisted biopsy of the breast: difference with US-detected and MRI-detected lesions. Breast Cancer 2009; 17:110-7. [DOI: 10.1007/s12282-009-0112-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Accepted: 03/09/2009] [Indexed: 10/20/2022]
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Davey HM, Barratt AL, Butow PN, Houssami N. The impact of different criteria for selecting information to be provided to women undergoing diagnostic breast tests. PATIENT EDUCATION AND COUNSELING 2008; 71:86-94. [PMID: 18249082 DOI: 10.1016/j.pec.2007.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2007] [Revised: 11/30/2007] [Accepted: 12/04/2007] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To determine if the content of written information for women undergoing diagnostic breast tests would change depending on the criteria used to decide what information should be included. METHODS Questionnaire study eliciting the views of advocates, breast physicians, breast surgeons, general practitioners, people with an interest in ethics, and women who had undergone breast tests on information that should be provided to women undergoing diagnostic breast tests. Different criteria were used to determine what information should be included in the written information. RESULTS Advocates, breast physicians, breast surgeons, general practitioners, people with an interest in ethics, and women who had undergone breast tests held significantly different views about the importance of specific information items for women undergoing tests. Different methods of resolving these differences in views lead to the inclusion of different information in patient information material. CONCLUSION This study highlights the practical necessity for guidelines for developing written information to include details about how to resolve differences in opinions about what information should be included in patient material. PRACTICE IMPLICATIONS Further research is needed to determine the most appropriate way to decide the content of written information. In the meantime, developers of written patient information need to be cognizant of the effects of their decisions on the content of patient information.
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Affiliation(s)
- Heather M Davey
- Centre for Values, Ethics and the Law in Medicine, School of Public Medicine, The University of Sydney, NSW 2006, Australia.
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12
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Uematsu T, Kasami M, Uchida Y, Yuen S, Sanuki J, Kimura K, Tanaka K. Ultrasonographically guided 18-gauge automated core needle breast biopsy with post-fire needle position verification (PNPV). Breast Cancer 2007; 14:219-28. [PMID: 17485909 DOI: 10.2325/jbcs.918] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Percutaneous imaging-guided core needle biopsy (CNB) is being used increasingly as an alternative to surgical biopsy for the diagnosis of breast lesions that are suspicious or highly suggestive of malignancy. The purpose of this study was to evaluate ultrasonographically (US) guided 18-gauge automated CNB with post-fire needle position verification (PNPV) in the assessment of US visible breast lesions. METHODS Biopsy of 235 US visible breast lesions was performed using US-guided 18-gauge core needles (18-GCN). After firing the biopsy needle, an image was obtained in the orthogonal plane to confirm the precise post-fire position of the needle track before removing the needle. Needle core diagnoses were compared with surgical diagnoses in 235 lesions subsequently surgically excised. RESULTS The median size of the lesions was 14 mm (range, 5-60 mm). Agreement between needle core and surgical diagnoses in the 235 lesions was 92% including 192 cancers, 28 benign lesions, and 3 high-risk lesions. In the remaining 12 discordant lesions, 4 were high-risk lesions and 8 were benign lesions. In all 8 benign lesions, imaging-histological discordance was present. The sensitivity of US guided 18-GCNB for breast cancer was 96% (199 of 207). In 71% (167/235) of the cases only one core with PNPV was made. No complications occurred. CONCLUSION US-guided 18-GCNB for sonographically-demonstrated discrete mass lesions with PNPV is an accurate core needle biopsy technique of breast cancer. During the course of tissue sampling, evaluating the post-fire needle tip position by obtaining an orthogonal view with ultrasonographic guidance is the key to predicting the yield regardless of the size of the needle or the number of core samples.
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Affiliation(s)
- Takayoshi Uematsu
- Department of Diagnostic Radiology, Shizuoka Cancer Center Hospital, Japan.
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Fenster A, Surry KJM, Mills GR, Downey DB. 3D ultrasound guided breast biopsy system. ULTRASONICS 2004; 42:769-774. [PMID: 15047381 DOI: 10.1016/j.ultras.2003.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Stereotactic X-ray mammography (SM) and ultrasound (US) guidance are commonly used techniques for breast biopsy. While SM provides 3D targeting information and US provides real-time guidance, both techniques have limitations. SM is a long and uncomfortable procedure and the US guided procedure is inherently 2D, requiring a skilled physician for both safety and accuracy. We have developed a 3D US-guided biopsy system to integrate with SM. The dual modality breast biopsy system combines the advantages of both approaches with 3D US and SM targeting, near real-time 3D and real-time 2D US guidance, breast stabilisation and a confined needle trajectory. Our goal is to be able to biopsy a larger percentage of suspicious masses using ultrasound, by clarifying ambiguous structures with mammographic imaging. Using breast phantoms, we have shown that our ultrasound guided biopsy system was capable of targeting artificial lesions that were 3.2 mm in diameter, with a 96% success rate. Through this study, we also demonstrated that our system was equivalent to current clinical practice, for an in vitro biopsy task. Metal beads in known relative positions allowed us to determine the geometry of the SM system, so that stereotactic mammography could be registered to 3D US images. The target registration error was found to be 1.6 mm. This error was dominated by positioning error in the vertical direction (perpendicular to the film surface). As an adjunct to SM, we propose that 3D US could provide more complete imaging information for target identification and real-time monitoring of needle insertion, as well as providing a means for rapid confirmation of biopsy success.
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Affiliation(s)
- A Fenster
- Imaging Research Laboratory, Robarts Research Institute, P.O. Box 5015, 100 Perth Drive, London, Ont., Canada N6A 5K8.
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Morris AM, Flowers CR, Morris KT, Schmidt WA, Pommier RF, Vetto JT. Comparing the cost-effectiveness of the triple test score to traditional methods for evaluating palpable breast masses. Med Care 2003; 41:962-71. [PMID: 12886175 DOI: 10.1097/00005650-200308000-00009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Physical examination, mammography, ultrasonography, and fine needle aspiration are traditionally used to guide further management of palpable breast masses, often leading to open biopsy of benign masses. The triple test score (TTS) integrates physical examination, mammography, and fine needle aspiration in the initial evaluation, limiting open biopsy. OBJECTIVE To compare cost-effectiveness of TTS and traditional methods. METHODS The primary measure of clinical effectiveness, frequency of missed malignancy, was determined for each strategy using probabilities and outcomes from a systematic literature review. Costs were calculated using the Medicare resource-based relative-value scale. A decision-analytic model compared costs of initial work-up, costs per mass evaluated, and costs per malignancy diagnosed. Sensitivity analyses assessed the influence of variations in model assumptions. RESULTS In the base case, neither strategy led to undiagnosed breast cancer. However, open biopsy was required in 13% of benign masses using TTS versus 88% using the traditional strategy. The cost of the initial work-up using traditional management was less than TTS (377 US dollars vs. 627 US dollars), but cost per mass evaluated and cost per malignancy diagnosed (1793 US dollars vs. 925 US dollars and 5670 US dollars vs. 2925 US dollars) favored TTS, due to substantially reduced open biopsy.In sensitivity analyses, TTS cost varied most with changes in cost of initial evaluation, whereas the traditional strategy cost varied most with changes in open biopsy cost. CONCLUSIONS The TTS provides equivalent diagnostic effectiveness but substantially lower cost than traditional management. Cost savings are based on decreased open biopsy, a major contributor to the cost of traditional evaluation in this model.
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Fishman JE, Milikowski C, Ramsinghani R, Velasquez MV, Aviram G. US-guided core-needle biopsy of the breast: how many specimens are necessary? Radiology 2003; 226:779-82. [PMID: 12601206 DOI: 10.1148/radiol.2263011622] [Citation(s) in RCA: 111] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To analyze the diagnostic yield for each specimen obtained at 14-gauge ultrasonography (US)-guided breast biopsy and compare these findings with mass, procedural, and specimen characteristics that could affect yield. MATERIALS AND METHODS Seventy-three consecutive biopsies of breast masses were performed by using a 14-gauge handheld biopsy device. Each specimen was graded for whether it was nonfragmented or fragmented and for whether it sank or floated, and each pass was graded for whether or not the needle passed through the lesion. Each specimen was mounted on a separate slide. A pathologist who was unaware of the final diagnoses reviewed the slides in random order. A diagnosis was determined for each specimen whenever possible, and diagnostic yield was calculated as a function of number of passes. The Fisher exact test was used to compare yield for different specimen characteristics. RESULTS Fourteen (19%) lesions were malignant and 59 (81%) were benign. Cells indicating the final diagnosis were contained in 249 (75%) of 334 specimens. Cells indicating the diagnosis were contained in the first specimen in 51 (70%) lesions, in the second specimen in 67 (92%), in the third specimen in 70 (96%), and in the fourth specimen in 73 (100%). Of the 14 malignancies, 13 (93%) were diagnosed with cells contained in the first or second specimen; one cancer (ductal carcinoma in situ) was diagnosed with cells contained in the fourth specimen. Specimens that were nonfragmented (P <.001) and sank (P <.001) showed correlation with being diagnostic, but needle visualization within the lesion did not. CONCLUSION A minimum of four specimens, preferably those that are nonfragmented and that sink, should be obtained with 14-gauge US-guided breast biopsy.
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Affiliation(s)
- Joel E Fishman
- Department of Radiology, University of Miami School of Medicine, Jackson Memorial Hospital Rm WW279, 1611 NW 12th Ave, Miami, FL 33136, USA.
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Surry KJM, Smith WL, Campbell LJ, Mills GR, Downey DB, Fenster A. The development and evaluation of a three-dimensional ultrasound-guided breast biopsy apparatus. Med Image Anal 2002; 6:301-12. [PMID: 12270234 DOI: 10.1016/s1361-8415(02)00087-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We have designed a prototype three-dimensional ultrasound guidance (3D USB) apparatus to improve the breast biopsy procedure. Features from stereotactic mammography and free-hand US-guided biopsy have been combined with 3D US imaging. This breast biopsy apparatus accurately guides a needle into position for the sampling of target tissue. We have evaluated this apparatus in three stages. First, by testing the placement accuracy of a needle in a tissue mimicking phantom. Second, with tissue mimicking phantoms that had embedded lesions for biopsy. Finally, by comparison to free-hand US-guided biopsy, using chicken breast phantoms. The first two stages of evaluation quantified the mechanical biases in the 3D USB apparatus. Compensating for these, a 96% success rate in targeting 3.2 mm "lesions" in chicken breast phantoms was achieved when using the 3D USB apparatus. The expert radiologists performing biopsies with free-hand US guidance achieved a 94.5% success rate. This has proven an equivalence between our apparatus, operated by non-experts, and free-hand biopsy performed by expert radiologists, for 3.2 mm lesions in vitro, with a 95% confidence.
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Affiliation(s)
- K J M Surry
- Imaging Research Laboratories, John P. Robarts Research Institute, PO Box 5015, 100 Perth Drive, London, Ontario, Canada N6A 5K8.
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Abstract
The surgeon continues to play a key role in the initial local/regional management of breast cancer. Breast conserving therapy (BCT) utilizing segmental mastectomy has been developed as an alternative to total mastectomy to improve cosmetic and psychosocial outcomes while retaining oncologic benefits. Developments in the surgical treatment of breast cancer have changed the way breast cancer is diagnosed and treated, and will likely continue to evolve in the future. This review highlights aspects of breast cancer treatment in which the surgical approach has evolved or is evolving, and comments on how the surgeon may participate in breast cancer care in the future.
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Affiliation(s)
- Richard J Bold
- Department of Surgery, Division of Surgical Oncology, Suite 3010, University of California, Davis Cancer Center, 4501 X Street, Sacramento, CA 95817, USA.
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Abstract
Image-guided breast biopsy has become an attractive alternative to wire-localized excisional biopsy to evaluate women with nonpalpable abnormalities detected by breast imaging. We have organized a database from our institution that includes over 3,500 procedures. We have reviewed our institutional results and the literature pertaining to image-guided breast biopsy. Discussed in this review are the indications and contraindications for image-guided biopsy, common techniques employed, accuracy based on pathology, reimbursement issues, and the multidisciplinary approach used at our institution. The results of our review affirm our position that image-guided breast biopsy is the preferred technique to evaluate women with nonpalpable breast imaging abnormalities.
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Affiliation(s)
- T A King
- Department of Surgery, Ochsner Clinic, Alton Ochsner Medical Foundation, 1514 Jefferson Highway, New Orleans, LA 70121, USA
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