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Yoen H, Chung HA, Lee SM, Kim ES, Moon WK, Ha SM. Hemorrhagic Complications Following Ultrasound-Guided Breast Biopsy: A Prospective Patient-Centered Study. Korean J Radiol 2024; 25:157-165. [PMID: 38288896 PMCID: PMC10831294 DOI: 10.3348/kjr.2023.0874] [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] [Received: 09/10/2023] [Revised: 11/13/2023] [Accepted: 11/29/2023] [Indexed: 02/01/2024] Open
Abstract
OBJECTIVE We aimed to evaluate the clinical and imaging factors associated with hemorrhagic complications and patient discomfort following ultrasound (US)-guided breast biopsy. MATERIALS AND METHODS We prospectively enrolled 94 patients who were referred to our hospital between June 2022 and December 2022 for US-guided breast biopsy. After obtaining informed consent, two breast radiologists independently performed US-guided breast biopsy and evaluated the imaging findings. A hemorrhagic complication was defined as the presence of bleeding or hematoma on US. The patients rated symptoms of pain, febrile sensation, swelling at the biopsy site, and dyspnea immediately, 20 minutes, and 2 weeks after the procedure on a visual analog scale, with 0 for none and 10 for the most severe symptoms. Additional details recorded included those of nausea, vomiting, bleeding, bruising, and overall satisfaction score. We compared the clinical symptoms, imaging characteristics, and procedural features between patients with and those without hemorrhagic complications. RESULTS Of 94 patients, 7 (7%) developed hemorrhagic complications, while 87 (93%) did not. The complication resolved with 20 minutes of manual compression, and no further intervention was required. Vascularity on Doppler examination (P = 0.008), needle type (P = 0.043), and lesion location (P < 0.001) were significantly different between the groups. Patients with hemorrhagic complications reported more frequent nausea or vomiting than those without hemorrhagic complications (29% [2/7] vs. 2% [2/87], respectively; P = 0.027). The overall satisfaction scores did not differ between the two groups (P = 0.396). After 2 weeks, all symptoms subsided, except bruising (50% 2/4 in the complication group and 25% [16/65] in the no-complication group). CONCLUSION US-guided breast biopsy is a safe procedure with a low complication rate. Radiologists should be aware of hemorrhagic complications, patient discomfort, and overall satisfaction related to this procedure.
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Affiliation(s)
- Heera Yoen
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyun-Ah Chung
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - So-Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eun-Sung Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Woo Kyung Moon
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Su Min Ha
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea.
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2
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Lewis JD, Groszkiewicz A, Hefelfinger L, Doherty A, Foringer A, Shaughnessy E, Heelan A, Brown AL. Clinically significant bleeding complications of percutaneous breast biopsy: 10-year analysis and a proposed management algorithm. Clin Imaging 2023; 104:110017. [PMID: 37979400 DOI: 10.1016/j.clinimag.2023.110017] [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: 09/12/2023] [Revised: 10/20/2023] [Accepted: 10/31/2023] [Indexed: 11/20/2023]
Abstract
PURPOSE Bleeding is a well-known risk of percutaneous breast biopsy, frequently controlled with manual pressure. However, significant bleeding complications may require further evaluation or intervention. Our objectives were to assess the rate, type, and periprocedural management of significant bleeding following percutaneous breast biopsy and to evaluate the success of any interventions. METHODS We retrospectively reviewed percutaneous breast biopsies at our institution over a 10-year period with documented post-biopsy bleeding complications in radiology reports. Patients were included if bleeding required intervention (interventional radiology [IR], surgery, or other), imaging follow-up, or clinical evaluation for symptoms. Additional data included patient demographics, anticoagulation, history of bleeding diathesis, biopsy details, bleeding symptoms, histopathology, and intervention details, if applicable. RESULTS Of 5820 unique patients who underwent percutaneous biopsy, 66 patients (66/5820; 1.1%) comprising 71 biopsy cases met inclusion for clinically significant bleeding with 5/71(7.0%) requiring surgery, 9/71(12.7%) requiring IR intervention, and 57/71(80.3%) requiring lower-acuity intervention including prolonged observation (5/57;7.0%), overnight admission (4/57;5.6%), aspiration (4/57;5.6%), lidocaine and suture (2/57;2.8%), primary care visit (7/57;10.0%), blood transfusion (1/57;1.4%), emergency room visit (6/57;8.5%), surgery consult (8/57;11.3%), IR consult (2/57;2.8%), and follow-up imaging (22/57;31.0%). Most patients requiring intervention by surgery or IR had acute signs of bleeding immediately after biopsy while most patients with delayed signs of bleeding required lower-acuity interventions. CONCLUSION Clinically significant bleeding is extremely rare after percutaneous breast biopsy and is most often managed non-surgically. Developing an institutional algorithm for management of bleeding complications that consults IR before surgery may help decrease the number of patients managed surgically.
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Affiliation(s)
- Jaime D Lewis
- Department of Surgery, University of Cincinnati Medical Center, 3188 Bellevue Avenue, Cincinnati, OH 45219, United States of America.
| | - Abigail Groszkiewicz
- University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267, United States of America.
| | - Leah Hefelfinger
- University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267, United States of America.
| | - Alexander Doherty
- University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267, United States of America.
| | - Alyssa Foringer
- University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267, United States of America.
| | - Elizabeth Shaughnessy
- Department of Surgery, University of Cincinnati Medical Center, 3188 Bellevue Avenue, Cincinnati, OH 45219, United States of America.
| | - Alicia Heelan
- Department of Surgery, University of Cincinnati Medical Center, 3188 Bellevue Avenue, Cincinnati, OH 45219, United States of America.
| | - Ann L Brown
- Department of Radiology, University of Cincinnati Medical Center, 3188 Bellevue Avenue, Cincinnati, OH 45219, United States of America.
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Goudreau S, Grimm LJ, Srinivasan A, Net J, Yang R, Dialani V, Dodelzon K. Bleeding Complications After Breast Core-needle Biopsy-An Approach to Managing Patients on Antithrombotic Therapy. JOURNAL OF BREAST IMAGING 2022; 4:241-252. [PMID: 38416973 DOI: 10.1093/jbi/wbac020] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Indexed: 03/01/2024]
Abstract
Image-guided core-needle breast and axillary biopsy (CNB) is the standard-of-care procedure for the diagnosis of breast cancer. Although the risks of CNB are low, the most common complications include bleeding and hematoma formation. Post-procedural bleeding is of particular concern in patients taking antithrombotic therapy, but there is currently no widely established standard protocol in the United States to guide antithrombotic therapy management. In the face of an increasing number of patients taking antithrombotic therapy and with the advent of novel classes of anticoagulants, the American College of Radiology guidelines recommend that radiologists consider cessation of antithrombotic therapy prior to CNB on a case-by-case basis. Lack of consensus results in disparate approaches to patients on antithrombotic therapy undergoing CNB. There is further heterogeneity in recommendations for cessation of antithrombotic therapy based on the modality used for image-guided biopsy, target location, number of simultaneous biopsies, and type of antithrombotic agent. A review of the available data demonstrates the safety of continuing antithrombotic therapy during CNB while highlighting additional procedural and target lesion factors that may increase the risk of bleeding. Risk stratification of patients undergoing breast interventional procedures is proposed to guide both pre-procedural decision-making and post-procedural management. Radiologists should be aware of antithrombotic agent pharmacokinetics and strategies to minimize post-procedural bleeding to safely manage patients.
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Affiliation(s)
- Sally Goudreau
- University of Texas Southwestern Medical Center, Department of Radiology, Dallas, TX, USA
| | - Lars J Grimm
- Duke University Medical Center, Department of Radiology, Durham, NC, USA
| | | | - Jose Net
- University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Roger Yang
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Vandana Dialani
- Beth Israel Lahey Health, Department of Radiology, Boston, MA, USA
| | - Katerina Dodelzon
- Weill Cornell at New York-Presbyterian, Department of Radiology, New York, NY, USA
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4
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Tahoun LA, Maraqa B. Ultrasound-guided vacuum-assisted breast biopsy in the diagnosis of cancer recurrence at the surgical scar: a report of three cases. J Ultrason 2022; 22:e57-e63. [PMID: 35449697 PMCID: PMC9009348 DOI: 10.15557/jou.2022.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 11/17/2021] [Indexed: 12/05/2022] Open
Abstract
Aim of the study Ultrasound-guided vacuum-assisted biopsy is being increasingly used in the diagnosis of breast lesions. The advantages of vacuum-assisted biopsy over core needle biopsy include large sample and higher diagnostic accuracy. Indications for ultrasound-guided vacuum-assisted biopsy include suspicious calcifications visible on ultrasound, architectural distortion, and very subtle or insinuating lesions. Case description We present three patients treated for breast cancer with breast-conserving surgery who developed suspicious findings on mammogram and MRI at or near the surgical scar. The findings were subtle, small, or atypical lesions on ultrasound. Ultrasound-guided vacuum-assisted biopsy was performed, and recurrence was diagnosed. The technique was advantageous due to real-time imaging, ability to control the path of the needle, obtaining multiple cores with a single skin puncture and single pass, supine position, no radiation, and no IV contrast. Conclusions Ultrasound-guided vacuum-assisted biopsy should be considered in cases involving multiple suspicious findings at or near the surgical scar, with subtle or atypical sonographic correlates. Vacuum-assisted biopsy is indicated; yet ultrasound guidance is more comfortable, no radiation and no contrast.
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Affiliation(s)
- Laila Abu Tahoun
- Department of Diagnostic Radiology - Breast Imaging Unit, King Hussein Cancer Center, Jordan
| | - Bayan Maraqa
- Department of Laboratory Medicine and Pathology, King Hussein Cancer Center, Jordan
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Vanni G, Pedini D, Materazzo M, Farinaccio A, Perretta T, Pistolese CA, Buonomo OC. Unusual Presentation of a Post-procedural Breast Hematoma: A Case Report. In Vivo 2021; 35:2957-2961. [PMID: 34410994 DOI: 10.21873/invivo.12589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 05/31/2021] [Accepted: 06/04/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Hematoma is the most frequent complication after Vacuum-Assisted Breast Biopsy (VABB) in 13% of cases. A direct communication channel with patients eases the diagnosis of VABB complications and ensures treatment at an early stage, as outpatients, in most cases. In 2020, due to the COVID-19 pandemic, we observed a reduction of self-reported postoperative complication leading to delay in the identification of harmful complications, therefore leading to need for more invasive treatment. CASE REPORT A 50-year-old patient was admitted to the Emergency Department for dry cough, fever, chest discomfort, dyspnea, and slight confusion four days after VABB. Due to the reported symptoms, the patient was sent to our COVID-19 Emergency Department. The COVID-19 swab was negative. Ultrasound revealed a large hematoma at the biopsy site, with active bleeding. Open evacuation with accurate hemostasis was planned with rapid and complete resolution of the clinical symptoms. After surgery, the patient reported that she intentionally avoided admittance in the hospital due to the risk of COVID-19 infection. The patient was discharged in the first postoperative day and maintained in quarantine for 14 days. CONCLUSION In the COVID-19 era due to the risk of hospital cross-infections, reduction of patient-doctor communication could lead to misdiagnosis, delay in recognition of procedural complications thus leading to requirement for invasive treatment, hospitalization, while also further multiplying the risk of COVID-19 infection.
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Affiliation(s)
- Gianluca Vanni
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Domiziana Pedini
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Marco Materazzo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy;
| | - Andrea Farinaccio
- Cardiac and Thoracic Anesthesia Unit, Tor Vergata University Hospital, Rome, Italy
| | - Tommaso Perretta
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Rome, Italy
| | - Chiara Adriana Pistolese
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Rome, Italy
| | - Oreste Claudio Buonomo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
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Hahn M, Preibsch H. [Interventional techniques for the breast]. Radiologe 2021; 61:159-165. [PMID: 33427890 DOI: 10.1007/s00117-020-00800-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Interventional methods of the breast serve as percutaneous minimally invasive diagnostic tools in case of suspicious findings in the breast or axilla. Further indications are lesion localization and the minimally invasive therapeutic approach. OBJECTIVES Aim of this paper is to give an overview of the existing methods, their indications and the imaging techniques for guidance. On the basis of the most recent publications, clinical management is described.
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Affiliation(s)
- M Hahn
- Department für Frauengesundheit, Universitätsklinikum Tübingen, Calwerstr. 7, 72076, Tübingen, Deutschland.
| | - H Preibsch
- Abteilung für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Tübingen, Tübingen, Deutschland
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7
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Gruber I, Oberlechner E, Heck K, Hoopmann U, Böer B, Fugunt R, Gall C, Hartkopf AD, Helms G, Hoffmann SM, Ott C, Röhm C, Stäbler A, Wallwiener D, Brucker SY, Hahn M. Percutaneous Ultrasound-Guided Core Needle Biopsy: Comparison of 16-Gauge versus 14-Gauge Needle and the Effect of Coaxial Guidance in 1065 Breast Biopsies - A Prospective Randomized Clinical Noninferiority Trial. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2020; 41:534-543. [PMID: 31791085 DOI: 10.1055/a-1014-2628] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE Ultrasound-guided core needle biopsy (CNB) is considered the standard assessment to diagnose sonographically visible suspicious breast mass lesions. Based on nonrandomized trials, the current German guidelines recommend at least three cylinders with ≤ 14-gauge needle biopsy. However, no recommendation is made as to how many specimens are needed with a smaller needle size, such as 16-gauge, or if biopsy with coaxial guidance improves diagnostic accuracy and quality. Therefore, in a prospective monocentric unblinded randomized controlled clinical noninferiority trial, the diagnostic accuracy of 16-gauge versus 14-gauge core needle biopsy, with and without coaxial guidance, was evaluated. MATERIALS AND METHODS 1065 breast biopsies were included in order to analyze the number of core samples necessary to obtain an appropriate rate of diagnostic quality adequate for histological evaluation, and to achieve high diagnostic accuracy and diagnostic yield. Histological results were verified by surgery or long-term follow-up of at least two years up to five years. RESULTS In order to obtain an additive diagnostic accuracy of > 99 %, a minimum of two cylinders with 14-gauge biopsy were required. The diagnostic accuracy and the diagnostic quality of 14-gauge biopsy were not affected by the coaxial technique. When performing a 16-gauge biopsy, five cylinders were required to achieve an additive diagnostic accuracy of > 99 %. Without coaxial guidance, 16-gauge CNB required at least three samples, whereas five needle passes with coaxial-guided 16-gauge biopsy were needed. CONCLUSION The diagnostic accuracy and quality of ultrasound-guided 16-gauge core needle biopsy were inferior to the 14-gauge needle size, regardless of the use of a coaxial technique.
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Affiliation(s)
- Ines Gruber
- Department of Women's Health, University of Tübingen, Germany
| | | | - Kerstin Heck
- Frauenklinik, Klinikum Stuttgart Olgahospital Frauenklinik, Stuttgart, Germany
| | - Uta Hoopmann
- Department of Women's Health, University of Tübingen, Germany
| | - Bettina Böer
- Department of Women's Health, University of Tübingen, Germany
| | - Regina Fugunt
- Department of Women's Health, University of Tübingen, Germany
| | - Christian Gall
- Department of Women's Health, University of Tübingen, Germany
| | | | - Gisela Helms
- Department of Women's Health, University of Tübingen, Germany
| | | | - Claudia Ott
- Department of Women's Health, University of Tübingen, Germany
| | - Carmen Röhm
- Department of Women's Health, University of Tübingen, Germany
| | - Annette Stäbler
- Institute of Pathology and Neuropathology, University of Tübingen, Germany
| | | | - Sara Y Brucker
- Department of Women's Health, University of Tübingen, Germany
| | - Markus Hahn
- Department of Women's Health, University of Tübingen, Germany
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8
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Lucioni M, Rossi C, Lomoro P, Ballati F, Fanizza M, Ferrari A, Garcia-Etienne CA, Boveri E, Meloni G, Sommaruga MG, Ferraris E, Lasagna A, Bonzano E, Paulli M, Sgarella A, Di Giulio G. Positive predictive value for malignancy of uncertain malignant potential (B3) breast lesions diagnosed on vacuum-assisted biopsy (VAB): is surgical excision still recommended? Eur Radiol 2020; 31:920-927. [PMID: 32816199 DOI: 10.1007/s00330-020-07161-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/20/2020] [Accepted: 08/06/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Breast lesions classified as of "uncertain malignant potential" represent a heterogeneous group of abnormalities with an increased risk of associated malignancy. Clinical management of B3 lesions diagnosed on vacuum-assisted breast biopsy (VABB) is still challenging: surgical excision is no longer the only available treatment and VABB may be sufficient for therapeutic excision. The aim of the present study is to evaluate the positive predictive value (PPV) for malignancy in B3 lesions that underwent surgical excision, identifying possible upgrading predictive factors and characterizing the malignant lesions eventually diagnosed. These results are compared with a subset of patients with B3 lesions who underwent follow-up. METHODS A total of 1250 VABBs were performed between January 2006 and December 2017 at our center. In total, 150 B3 cases were diagnosed and 68 of them underwent surgical excision. VABB findings were correlated with excision histology. A PPV for malignancy for each B3 subtype was derived. RESULTS The overall PPV rate was 28%, with the highest upgrade rate for atypical ductal hyperplasia (41%), followed by classical lobular neoplasia (29%) and flat epithelial atypia (11%). Only two cases of carcinoma were detected in the follow-up cohort, both associated with atypical ductal hyperplasia at VABB. CONCLUSION Open surgery is recommended in case of atypical ductal hyperplasia while, for other B3 lesions, excision with VABB only may be an acceptable alternative if radio-pathological correlation is assessed, if all microcalcifications have been removed by VABB, and if the lesion lacks high-risk cytological features. KEY POINTS • Surgical treatment is strongly recommended in case of ADH, while the upgrade rate in case of pure FEA, especially following complete microcalcification removal by VABB, may be sufficiently low to advice surveillance as a management strategy. • The use of 11-G- or 8-G-needle VABB, resulting in possible complete diagnostic excision of the lesion, can be an acceptable alternative in case of RS, considering open surgery only for selected high-risk patients. • LN management is more controversial: surgical excision may be recommended following classical LN diagnosis on breast biopsy if an additional B3 lesion is concurrently detected while in the presence of isolated LN with adequate radiological-pathological correlation follow-up alone could be an acceptable option.
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Affiliation(s)
- Marco Lucioni
- Anatomic Pathology Section, Department of Human Pathology, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Chiara Rossi
- Anatomic Pathology Section, Department of Human Pathology, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Pascal Lomoro
- Breast Imaging Department, Valduce Hospital, Via Dante Alighieri 11, 22100, Como, Italy.
| | - Francesco Ballati
- Breast Imaging Department, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marianna Fanizza
- Breast Imaging Department, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alberta Ferrari
- Breast Surgery Department, Fondazione IRCCS Policlinico San Matteo, Università degli Studi di Pavia, Pavia, Italy
| | - Carlos A Garcia-Etienne
- Breast Surgery Department, Fondazione IRCCS Policlinico San Matteo, Università degli Studi di Pavia, Pavia, Italy
| | - Emanuela Boveri
- Anatomic Pathology Section, Department of Human Pathology, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giulia Meloni
- Breast Imaging Department, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Maria Grazia Sommaruga
- Breast Imaging Department, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Elisa Ferraris
- Medical Oncology, Fondazione IRCCS Policlinico San Matteo and, Università degli Studi, Pavia, Italy
| | - Angioletta Lasagna
- Medical Oncology, Fondazione IRCCS Policlinico San Matteo and, Università degli Studi, Pavia, Italy
| | - Elisabetta Bonzano
- University of Pavia and Department of Radiation Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marco Paulli
- Anatomic Pathology Section, Department of Human Pathology, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Adele Sgarella
- Breast Surgery Department, Fondazione IRCCS Policlinico San Matteo, Università degli Studi di Pavia, Pavia, Italy
| | - Giuseppe Di Giulio
- Breast Imaging Department, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Lian ZQ, Yu HY, Zhang AQ, Xie SM, Wang Q. Use of urinary balloon catheter to prevent postoperative bleeding after ultrasound-guided vacuum-assisted breast biopsy. Breast J 2019; 26:144-148. [PMID: 31650650 DOI: 10.1111/tbj.13484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 04/14/2019] [Accepted: 04/15/2019] [Indexed: 11/30/2022]
Abstract
Postoperative bleeding is the most frequent serious complications after vacuum-assisted breast biopsy (VABB). The aim of this study was to evaluate the clinical effect of using urinary balloon catheter to prevent postoperative bleeding after ultrasound-guided VABB. From May 2016 to June 2018, 324 patients who underwent ultrasound-guided VABB were randomized into the study group and control group. In the study group, an urinary balloon catheter was inserted into the excision cavity to prevent bleeding and hematoma. In the control group, compression with thorax pressure bandage was used for hemostasis. Postoperative subcutaneous ecchymosis and hematoma were recorded and compared between the two groups. The rates of postoperative ecchymosis and hematoma in the study group were significantly lower than that in the control group (5.6% vs 13.0%, P < .05; 8.0% vs 20.4%, P < .05). Among patients with lesions ≤1.5 cm, the rates of postoperative ecchymosis and hematoma were 2.9% and 4.3% in the study group, 6.5% and 11.7% in the control group, but there was no statistically significant difference between the two groups (P > .05). Among patients with lesions >1.5 cm, the rates of postoperative ecchymosis and hematoma in the study group were significantly lower than that in the control group (7.6% vs 18.8%, P < .05; 10.9% vs 28.2%, P < .05). Hemostasis with balloon urinary catheter is a safe and effective method to prevent postoperative bleeding after VABB.
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Affiliation(s)
- Zhen-Qiang Lian
- The First Clinical Medical College of Jinan University, Jinan University, Guangzhou, Guangdong, China.,Breast disease center, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Hai-Yun Yu
- Breast disease center, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - An-Qin Zhang
- Breast disease center, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Si-Mei Xie
- Breast disease center, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Qi Wang
- The First Clinical Medical College of Jinan University, Jinan University, Guangzhou, Guangdong, China.,Breast disease center, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
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10
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Overstated Harms of Breast Cancer Screening? A Large Outcomes Analysis of Complications Associated With 9-Gauge Stereotactic Vacuum-Assisted Breast Biopsy. AJR Am J Roentgenol 2019; 212:925-932. [DOI: 10.2214/ajr.18.20421] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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11
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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.
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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
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12
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De Falco I, Culmone C, Menciassi A, Dankelman J, van den Dobbelsteen JJ. A variable stiffness mechanism for steerable percutaneous instruments: integration in a needle. Med Biol Eng Comput 2018; 56:2185-2199. [PMID: 29862469 DOI: 10.1007/s11517-018-1847-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 05/16/2018] [Indexed: 12/19/2022]
Abstract
Needles are advanced tools commonly used in minimally invasive medical procedures. The accurate manoeuvrability of flexible needles through soft tissues is strongly determined by variations in tissue stiffness, which affects the needle-tissue interaction and thus causes needle deflection. This work presents a variable stiffness mechanism for percutaneous needles capable of compensating for variations in tissue stiffness and undesirable trajectory changes. It is composed of compliant segments and rigid plates alternately connected in series and longitudinally crossed by four cables. The tensioning of the cables allows the omnidirectional steering of the tip and the stiffness tuning of the needle. The mechanism was tested separately under different working conditions, demonstrating a capability to exert up to 3.6 N. Afterwards, the mechanism was integrated into a needle, and the overall device was tested in gelatine phantoms simulating the stiffness of biological tissues. The needle demonstrated the capability to vary deflection (from 11.6 to 4.4 mm) and adapt to the inhomogeneity of the phantoms (from 21 to 80 kPa) depending on the activation of the variable stiffness mechanism. Graphical abstract ᅟ.
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Affiliation(s)
- Iris De Falco
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy.
| | - Costanza Culmone
- Department of BioMechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | | | - Jenny Dankelman
- Department of BioMechanical Engineering, Delft University of Technology, Delft, The Netherlands
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Ruggirello I, Nori J, Desideri I, Saieva C, Giannotti E, Bicchierai G, De Benedetto D, Francolini G, Bianchi S, Vezzosi V, Sanchez L, Susini T, Orzalesi L, Meattini I, Livi L, Miele V. Stereotactic vacuum-assisted breast biopsy: Comparison between 11- and 8-gauge needles. Eur J Surg Oncol 2017; 43:2257-2260. [PMID: 29042074 DOI: 10.1016/j.ejso.2017.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 07/01/2017] [Indexed: 10/18/2022] Open
Abstract
PURPOSE The 11-gauge (11G) stereotactic vacuum-assisted breast biopsy (VABB) showed a better profile than 14G-VABB in terms of feasibility, safety, microcalcification sampling, and accuracy. Underestimation rates were significantly lower with 11G-VABB than with 14G-VABB. Thus, the introduction of an even larger needle at the VABB procedure could reduce this rate further. The purpose of this study was to compare the overall performance of stereotactic VABB with 8G and 11G needles. MATERIALS AND METHODS Four hundred and three VABBs performed between July 2012 and February 2015 at the Breast Diagnostic Unit of Careggi Hospital in Florence were retrospectively analyzed; 197 were performed with 11G-VABB and 206 with 8G-VABB. Lesions were classified according to mammographical patterns in microcalcifications, architectural distortions, or opacities, and all biopsy targets were classified according to BIRADS classification as BIRADS III, IV or V. Data were collected on radiological classification of targets, imaging presentation, procedure time, number of specimens per procedure, and microcalcification retrieval on histological findings. Surgery was always performed when high-risk or malignant lesions (B3 or B5) were detected; the final diagnosis was made on surgical pathology. RESULTS Compared to VABB with an 11G needle, 8G-VABB allows a reduction in the time needed to complete the procedure (20.6 versus 27.4, P < 0.00001) and the number of specimens collected per lesion (21.6 versus 12.2, P < 0.00001). Moreover, 8G-VABB resulted in the same diagnostic accuracy, and the underestimation rates were comparable between the two groups for both B3 and DCIS lesions. CONCLUSIONS The 8G needle should be considered as a valid alternative option in VABB for breast lesions.
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Affiliation(s)
- Irene Ruggirello
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Jacopo Nori
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Isacco Desideri
- Department of Radiation Oncology, University of Florence, Florence, Italy.
| | - Calogero Saieva
- Molecular & Nutritional Epidemiology Unit, Cancer Research & Prevention Institute (ISPO), University of Florence, Florence, Italy
| | - Elisabetta Giannotti
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Giulia Bicchierai
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Diego De Benedetto
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Giulio Francolini
- Department of Radiation Oncology, University of Florence, Florence, Italy
| | - Simonetta Bianchi
- Division of Pathological Anatomy, Department of Medical & Surgical Critical Care, University of Florence, Florence, Italy
| | - Vania Vezzosi
- Division of Pathological Anatomy, Department of Medical & Surgical Critical Care, University of Florence, Florence, Italy
| | - Luis Sanchez
- Breast Surgery Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Tommaso Susini
- Breast Surgery Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Lorenzo Orzalesi
- Breast Surgery Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Icro Meattini
- Department of Radiation Oncology, University of Florence, Florence, Italy
| | - Lorenzo Livi
- Department of Radiation Oncology, University of Florence, Florence, Italy
| | - Vittorio Miele
- Radiology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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14
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Preibsch H, Baur A, Wietek BM, Krämer B, Staebler A, Claussen CD, Siegmann-Luz KC. Vacuum-assisted breast biopsy with 7-gauge, 8-gauge, 9-gauge, 10-gauge, and 11-gauge needles: how many specimens are necessary? Acta Radiol 2015; 56:1078-84. [PMID: 25232187 DOI: 10.1177/0284185114549224] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Accepted: 07/28/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Published national and international guidelines and consensus meetings on the use of vacuum-assisted biopsy (VAB) give different recommendations regarding the required numbers of tissue specimens depending on needle size and imaging method. PURPOSE To evaluate the weights of specimens obtained with different VAB needles to facilitate the translation of the required number of specimens between different breast biopsy systems and needle sizes, respectively. MATERIAL AND METHODS Five different VAB systems and seven different needle sizes were used: Mammotome® (11-gauge (G), 8-G), Vacora® (10-G), ATEC Sapphire™ (9-G), 8-G Mammotome® Revolve™, and EnCor Enspire® (10-G, 7-G). We took 24 (11-G) or 20 (7-10-G) tissue cores from a turkey breast phantom. The mean weight of a single tissue core was calculated for each needle size. A matrix, which allows the translation of the required number of tissue cores for different needle sizes, was generated. Results were compared to the true cumulative tissue weights of consecutively harvested tissue cores. RESULTS The mean tissue weights obtained with the 11-G / 10-G Vacora® / 10-G Enspire® / 9-G / 8-G Original / 8-G Revolve™ / 7-G needles were 0.084 g / 0.142 g / 0.221 g / 0.121 g / 0.192 g / 0.334 g / 0.363 g, respectively. The calculated required numbers of VAB tissue cores for each needle size build the matrix. For example, the minimum calculated number of required cores according to the current German S3 guideline is 20 / 12 / 8 / 14 / 9 / 5 / 5 for needles of 11-G / 10-G Vacora® / 10-G Enspire® / 9-G / 8-G Original / 8-G Revolve™ / 7-G size. These numbers agree with the true cumulative tissue weights. CONCLUSION The presented matrix facilitates the translation of the required number of VAB specimens between different needle sizes and thereby eases the implementation of current guidelines and consensus recommendations into clinical practice.
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Affiliation(s)
- Heike Preibsch
- University Department of Radiology Diagnostic and Interventional Radiology, Tübingen, Germany
| | - Astrid Baur
- University Department of Radiology Diagnostic and Interventional Radiology, Tübingen, Germany
| | - Beate M Wietek
- University Department of Radiology Diagnostic and Interventional Radiology, Tübingen, Germany
| | - Bernhard Krämer
- University Department of Gynecology and Obstetrics, Tübingen, Germany
| | - Annette Staebler
- Institute of Pathology and Neuropathology (Department), Tübingen, Germany
| | - Claus D Claussen
- University Department of Radiology Diagnostic and Interventional Radiology, Tübingen, Germany
| | - Katja C Siegmann-Luz
- University Department of Radiology Diagnostic and Interventional Radiology, Tübingen, Germany
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Pan S, Liu W, Jin K, Liu Y, Zhou Y. Ultrasound-guided vacuum-assisted breast biopsy using Mammotome biopsy system for detection of breast cancer: results from two high volume hospitals. Int J Clin Exp Med 2014; 7:239-246. [PMID: 24482711 PMCID: PMC3902263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Accepted: 12/11/2013] [Indexed: 06/03/2023]
Abstract
Ultrasound-guided vacuum-assisted breast biopsy (VABB) has been recently regarded as a feasible, effective, minimally invasive and safe method for removal of benign breast lesions without serious complications. The frequency of detection of noninvasive malignant breast lesions by ultrasound-guided VABB is increasing. The aim of this study was to evaluate the role of the ultrasound-guided VABB using Mammotome biopsy system in the early detection of breast cancer. Retrospective review between January 2008 to March 2013 the First Affiliated Hospital, Zhejiang University School of Medicine and Taizhou Hospital, Wenzhou Medical College. From January 2008 to March 2013, a total of 5232 ultrasound-guided VABB procedures were performed in 3985 patients whose mean ages were 36.3 years (range: 16-73). The histological results of 5232 ultrasound-guided VABB were retrospectively reviewed. Ultrasonography follow-up was performed at 3 to 6 month intervals in order to assess recurrence. Two hundred twenty three high risk lesions (comprising 59 papilloma, 57 papillomatosis, and 107 atypical hyperplasia) and 61 malignant lesions (comprising 23 ductal carcinoma in situ, 21 lobular carcinoma in situ, 12 infiltrating ductal carcinoma, and 5 infiltrating mucinous carcinoma) were identified. Sensitivity (100%) and diagnostic accuracy (100%) regarding the detection of malignancy were excellent for ultrasound-guided VABB using Mammotome biopsy system. Our results indicate that ultrasound-guided VABB using Mammotome biopsy system is an accurate technique for the sampling, diagnosis, and early detection of breast cancer. It is recommended that the Mammotome biopsy system could be as the method of choice for detecting nonpalpable early breast cancer.
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Affiliation(s)
- Shaobo Pan
- Operating Room, The First Affiliated Hospital, Zhejiang University School of Medicine, HangzhouZhejiang 310003, China
| | - Wenguang Liu
- Department of Emergency Surgery, Linyi People’s HospitalLinyi, Shandong 276000, China
| | - Ketao Jin
- Department of Surgical Oncology, Taizhou Hospital, Wenzhou Medical CollegeLinhai, Zhejiang 317000, China
| | - Yu Liu
- Department of Breast Surgery, The First Affiliated Hospital, Zhejiang University School of MedicineHangzhou, Zhejiang 310003, China
| | - Yunxiao Zhou
- Department of Gynecology, The First Affiliated Hospital, Zhejiang University School of MedicineHangzhou, Zhejiang 310003, China
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16
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Jiang Y, Lan H, Ye Q, Jin K, Zhu M, Hu X, Teng L, Cao F, Lin X. Mammotome ® biopsy system for the resection of breast lesions: Clinical experience in two high-volume teaching hospitals. Exp Ther Med 2013; 6:759-764. [PMID: 24137261 PMCID: PMC3786805 DOI: 10.3892/etm.2013.1191] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 06/21/2013] [Indexed: 11/06/2022] Open
Abstract
Ultrasound-guided vacuum-assisted breast biopsy (VABB) is regarded as a feasible, effective, minimally invasive and safe method for the removal of benign breast lesions, without the occurrence of serious complications. The aim of this study was to evaluate the feasibility, efficacy and safety of ultrasound-guided VABB using the Mammotome® biopsy system in the treatment of breast lesions. The clinical outcomes of 3,681 patients with breast lesions were evaluated following excisions by ultrasound-guided VABB in two high-volume teaching hospitals. From January 2008 to December 2012, a total of 4,867 ultrasound-guided VABB procedures were performed in the 3,681 patients, who had a mean age of 37.8 years (range, 16-73 years). The parameters examined in this analysis included lesion size, lesion location in the inner breast, Breast Imaging Reporting and Data System (BI-RADS) ultrasound category and histopathological diagnosis. Ultrasonography follow-up was performed at 3-6 month intervals in order to assess recurrence. The size of the investigated lesions ranged between 6 and 62 mm and a histopathological diagnosis was made in 100% of cases. The results indicated that the majority of specimens (98.89%) were benign. On average, the ultrasound-guided VABB was performed in 10.3 min (range, 7.5-43 min) and the mean number of cores removed in the procedure was 8.1 (range, 3-32). A complete excision was achieved in the majority of cases (99.7%). The presence of a hematoma was the most common complication following the biopsy, and was observed in 27.5% of patients. The mean follow-up period was 25.5 months (range, 1-60 months), during which the rate of recurrence was 4.4%. The results indicated that ultrasound-guided VABB using the Mammotome biopsy system is an effective and safe procedure that is able to rapidly remove the majority of benign breast lesions using a small incision and without the occurrence of scarring or complications.
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Affiliation(s)
- Yangping Jiang
- Department of Surgical Oncology, Dongyang Hospital, Wenzhou Medical University, Dongyang, Zhejiang 322100, P.R. China
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17
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Al-Harethee W, Theodoropoulos G, Filippakis GM, Papapanagiotou I, Matiatou M, Georgiou G, Kalles V, Koulocheri D, Nonni A, Konstadoulakis MM, Manouras A, Zografos GC. Complications of percutaneous stereotactic vacuum assisted breast biopsy system utilizing radio frequency. Eur J Radiol 2013; 82:623-6. [DOI: 10.1016/j.ejrad.2011.12.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Revised: 12/18/2011] [Accepted: 12/19/2011] [Indexed: 10/14/2022]
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18
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Venkataraman S, Dialani V, Gilmore HL, Mehta TS. Stereotactic core biopsy: Comparison of 11 gauge with 8 gauge vacuum assisted breast biopsy. Eur J Radiol 2012; 81:2613-9. [DOI: 10.1016/j.ejrad.2011.10.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2011] [Revised: 10/21/2011] [Accepted: 10/27/2011] [Indexed: 10/14/2022]
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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.
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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.
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Luo HJ, Chen X, Tu G, Wang J, Wu CY, Yang GL. Therapeutic Application of Ultrasound-Guided 8-Gauge Mammotome System in Presumed Benign Breast Lesions. Breast J 2011; 17:490-7. [DOI: 10.1111/j.1524-4741.2011.01125.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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21
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Kettritz U. Minimally Invasive Biopsy Methods - Diagnostics or Therapy? Personal Opinion and Review of the Literature. Breast Care (Basel) 2011; 6:94-97. [PMID: 21673818 PMCID: PMC3104898 DOI: 10.1159/000327889] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
SUMMARY: This article provides an overview of different minimally invasive biopsy (MIB) methods for preoperative assessment of suspicious and indeterminate breast lesions. Accuracy depends on the choice of method and on lesion characteristics. An additional aspect deals with the question whether or not MIB is a suitable therapeutic approach in selected lesions.
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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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Ames V, Britton PD. Stereotactically guided breast biopsy: a review. Insights Imaging 2011; 2:171-176. [PMID: 22347945 PMCID: PMC3259391 DOI: 10.1007/s13244-010-0064-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Revised: 12/03/2010] [Accepted: 12/22/2010] [Indexed: 11/27/2022] Open
Abstract
The aims of this review are to compare and contrast the available stereotactic equipment, and to describe the variety of needle types used and their affect on pathological results and subsequent patient management. Initial stereotactic devices were "added-on" to analogue mammography units and have been replaced by prone or ducubitus equipment using digital image acquisition. Biopsies use either 14-G core biopsy (CB) needles or vacuum-assisted biopsies (VAB). Vacuum-assisted biopsy systems consistently out-perform 14-G CB with reduced need for diagnostic or multi-treatment surgery. The false-negative rate is 8% for 14-G CB compared with 0.7% for VAB. There is a risk of underestimating the disease present for lesions of uncertain malignant potential (Cat B3) and suspicious of malignancy (Cat B4) results with 25% of patients with a B3 biopsy found to have cancer at subsequent surgery and 66% of those with a B4 biopsy. A CB diagnosis of in situ malignancy is upgraded to invasive disease at surgery in 15-36% of patients undergoing CB and of the order of 10% with VAB. A high degree of diagnostic accuracy and hence safe patient care can only be achieved by meticulous attention to technique and multi-disciplinary cooperation.
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Affiliation(s)
- Victoria Ames
- Department of Radiology, Cambridge Breast Unit, Addenbrooke's Hospital, Box 97, Cambridge, UK CB2 2QQ
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24
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Mammotome versus ATEC: a comparison of two breast vacuum biopsy techniques under sonographic guidance. Arch Gynecol Obstet 2009; 281:287-92. [PMID: 19404655 DOI: 10.1007/s00404-009-1101-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2009] [Accepted: 04/15/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE The study evaluates the differences between the Mammotome (MT) and ATEC (A) vacuum biopsy (VB) of the breast in terms of diagnostic reliability, biopsy duration and complications. METHODS In a prospective randomized study, 62 ultrasound-guided VBs of the breast were performed. MT and A were compared using Mann-Whitney U test. RESULTS The mean lesion size and the BI-RADS distribution were equal in both groups. Representative tissue was extracted in all 62 biopsies; thus no repeat biopsies were necessary. A sonographically guided complete excision was possible in 46 cases. More imaging-guided complete excisions were achieved with the MT than with A (87 vs. 63%). Technical complications occurred twice with A and once with MT. No medical complications occurred in either group. CONCLUSIONS Both systems are suitable for the diagnostic clarification of unclear breast lesions as well as complete excision of benign lesions under sonographic imaging. Sonographically guided complete resection was achieved more often with the MT.
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