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Sharma S, White C, Appavoo S, Yong-Hing CJ. Optimizing Patient-Centered Care in Breast Imaging: Strategies for Improving Patient Experience. Acad Radiol 2024:S1076-6332(24)00278-2. [PMID: 38760272 DOI: 10.1016/j.acra.2024.04.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 04/25/2024] [Accepted: 04/26/2024] [Indexed: 05/19/2024]
Affiliation(s)
- Sonali Sharma
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Cheryl White
- Community Access to Ventilation Information (CAVI), Toronto, Canada
| | - Shushiela Appavoo
- Department of Radiology and Diagnostic Imaging, University of Alberta, 2A2.41 WMC 8440-112 Street, Edmonton, Alberta, AB T6G 2B7, Canada
| | - Charlotte J Yong-Hing
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Diagnostic Imaging, BC Cancer, Vancouver, British Columbia, Canada
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Prabhu VG, Sprouse HA, Brignull CG, Snider R, Tanner S, Adams KJ, B Nisonson A, Hand WR, Epling JA. The Impact of Virtual Reality on Anxiety and Pain During US-Guided Breast Biopsies: A Randomized Controlled Clinical Trial. JOURNAL OF BREAST IMAGING 2024; 6:45-52. [PMID: 38243861 DOI: 10.1093/jbi/wbad088] [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: 08/01/2023] [Indexed: 01/22/2024]
Abstract
OBJECTIVE To investigate the efficacy of immersive virtual reality (VR) in combination with standard local anesthetic for mitigating anxiety and pain during US-guided breast biopsies compared to local anesthetic alone. METHODS Patients scheduled for US-guided biopsy were invited to participate. Eligible patients were females 18 years of age or older. Patients were randomized to VR or control group at a 1:1 ratio. Patients in the VR group underwent biopsy with the addition of a VR experience and patients in the control group underwent usual biopsy. Patient-perceived levels of anxiety and pain were collected before and after biopsy via the State-Trait Anxiety Inventory (STAI) and Visual Analog Scale (VAS). Physiological data were captured during biopsy using a clinically validated wristband. Differences in anxiety, pain, and physiologic data were compared between the VR and control group. RESULTS Sixty patients were enrolled. After excluding 2 patients with VR device malfunction, there were 29 patients in the VR and 29 patients in the control group for analysis. The VR group had reduced anxiety compared to the control group based on postintervention STAI (P <.001) and VAS (P = .036). The VR group did not have lower pain based on postintervention VAS (P = .555). Physiological measures showed higher RR intervals and decreased skin conductance levels, which are associated with lower anxiety levels in the VR group. CONCLUSION Use of VR in addition to standard local anesthetic for US-guided breast biopsies was associated with reduced patient anxiety. Virtual reality may be a useful tool to improve the patient biopsy experience.
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Affiliation(s)
| | - Harper A Sprouse
- Department of Anesthesiology, Prisma Health - Upstate, Greenville, SC, USA
| | | | - Rebecca Snider
- Department of Anesthesiology, Prisma Health - Upstate, Greenville, SC, USA
| | - Stephanie Tanner
- Department of Anesthesiology, Prisma Health - Upstate, Greenville, SC, USA
| | - Kyle J Adams
- Department of Anesthesiology, Prisma Health - Upstate, Greenville, SC, USA
| | - Andrea B Nisonson
- Department of Anesthesiology, Prisma Health - Upstate, Greenville, SC, USA
| | - William R Hand
- Department of Anesthesiology, Prisma Health - Upstate, Greenville, SC, USA
| | - James A Epling
- Department of Anesthesiology, Prisma Health - Upstate, Greenville, SC, USA
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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.
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AKIN ME. Pain levels of patients undergoing ultrasound guided biopsies and associated factors: a cross-sectional study. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1035199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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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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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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Impact of Sodium Bicarbonate-Buffered Lidocaine on Patient Pain During Image-Guided Breast Biopsy. J Am Coll Radiol 2017; 14:1194-1201. [PMID: 28527821 DOI: 10.1016/j.jacr.2017.03.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/28/2017] [Accepted: 03/29/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE This randomized, double-blind controlled study evaluated the effectiveness of sodium bicarbonate-buffered lidocaine on reducing pain during imaging-guided breast biopsies. MATERIALS AND METHODS This prospective, HIPAA-compliant study randomly assigned 85 women undergoing ultrasound- or stereotactic-guided core-needle breast biopsies to receive intradermally and intraparenchymally either 1% lidocaine buffered with sodium bicarbonate (9:1 ratio) (bicarbonate study group) or 1% lidocaine alone (control group). Pain was evaluated using a 0-to-10 Likert pain scale during both intradermal and intraparenchymal anesthesia injections and during tissue sampling. Prebiopsy breast pain, anxiety, medical history, demographics, biopsy type, radiologist level of training, breast density, and lesion histology were recorded. Data were analyzed using analysis of variance and analysis of covariance. RESULTS Unadjusted mean pain scores were 1.47 and 2.07 (study and control groups, respectively; P = .15) during intradermal injections, and 1.84 and 2.98 (study and control groups, respectively; P = .03) during intraparenchymal injections. Tissue sampling mean pain scores were .81 and 1.71 (study and control groups, respectively; P = .07). Moderator analyses found (1) among patients with preprocedural pain, those in the bicarbonate group experienced less intradermal injection pain (0.85 ± 1.23) than patients in the control group (2.50 ± 2.09); (2) among patients with fatty or scattered fibroglandular tissue, those in the bicarbonate group (1.35 ± 1.95) experienced less intraparenchymal injection pain than the control group (3.52 ± 3.13); and (3) during ultrasound-guided biopsies, patients in the bicarbonate group experienced less tissue-sampling pain (0.23 ± 0.63) than the control group (1.79 ± 3.05). CONCLUSIONS Overall, buffering lidocaine with sodium bicarbonate significantly reduced pain during intraparenchymal injections, and additional pain reduction was found in certain patient subgroups during intradermal injections, intraparenchymal injections, and tissue sampling.
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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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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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Hemmer JM, Kelder JC, van Heesewijk HPM. Stereotactic large-core needle breast biopsy: analysis of pain and discomfort related to the biopsy procedure. Eur Radiol 2007; 18:351-4. [PMID: 17909818 PMCID: PMC2668619 DOI: 10.1007/s00330-007-0762-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2006] [Revised: 07/18/2007] [Accepted: 08/27/2007] [Indexed: 12/03/2022]
Abstract
The purpose of this study was to determine the significance of variables such as duration of the procedure, type of breast tissue, number of passes, depth of the biopsies, underlying pathology, the operator performing the procedure, and their effect on women’s perception of pain and discomfort during stereotactic large-core needle breast biopsy. One hundred and fifty consecutive patients with a non-palpable suspicious mammographic lesions were included. Between three and nine 14-gauge breast passes were taken using a prone stereotactic table. Following the biopsy procedure, patients were asked to complete a questionnaire. There was no discomfort in lying on the prone table. There is no relation between type of breast lesion and pain, underlying pathology and pain and performing operator and pain. The type of breast tissue is correlated with pain experienced from biopsy (P = 0.0001). We found out that patients with dense breast tissue complain of more pain from biopsy than patients with more involution of breast tissue. The depth of the biopsy correlates with pain from biopsy (P = 0.0028). Deep lesions are more painful than superficial ones. There is a correlation between the number of passes and pain in the neck (P = 0.0188) and shoulder (P = 0.0366). The duration of the procedure is correlated with pain experienced in the neck (P = 0.0116) but not with pain experienced from biopsy.
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Affiliation(s)
- Judith M. Hemmer
- Department of Radiology, St. Antonius Hospital, Koekoekslaan 1, Nieuwegein, 3435 CM The Netherlands
| | - Johannes C. Kelder
- Department of Statistics, St. Antonius Hospital, Koekoekslaan 1, Nieuwegein, 3435 CM The Netherlands
| | - Hans P. M. van Heesewijk
- Department of Radiology, St. Antonius Hospital, Koekoekslaan 1, Nieuwegein, 3435 CM The Netherlands
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Zagouri F, Sergentanis TN, Gounaris A, Koulocheri D, Nonni A, Domeyer P, Fotiadis C, Bramis J, Zografos GC. Pain in different methods of breast biopsy: emphasis on vacuum-assisted breast biopsy. Breast 2007; 17:71-5. [PMID: 17869106 DOI: 10.1016/j.breast.2007.07.039] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2007] [Revised: 07/05/2007] [Accepted: 07/06/2007] [Indexed: 11/22/2022] Open
Abstract
This study examines pain (visual analog scale 0-10) in women undergoing breast biopsy. Two hundred and twenty-seven patients with a palpable lesion underwent FNA (21G, n=85), core biopsy (14G, n=86) or open biopsy under local anesthesia (n=56). One hundred and twenty-six women presented with a non-palpable lesion, and underwent vacuum-assisted breast biopsy (VABB, 11G) under mammographic guidance, prone position (n=72) or hook-wire localization followed by open surgery (n=54). The techniques sampling non-palpable lesions were the most painful: hook-wire (9.15+/-0.74) and VABB (4.35+/-1.70). Larger needle diameter was associated with more intense pain. Concerning VABB, an S-shape curve of pain (third-order pattern) was documented. A second dose of lidocaine just before the rapid increase phase was then adopted (n=61), and reduced the total/maximum pain. In conclusion, although VABB is less painful than hook-wire, the pain experienced in VABB is significant; however, it can be attenuated by a second dose of lidocaine.
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Affiliation(s)
- Flora Zagouri
- Breast Unit, First Department of Propaedeutic Surgery, Hippokratio Hospital, University of Athens, Greece
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