Image-guided breast biopsy and localisation: recommendations for information to women and referring physicians by the European Society of Breast Imaging

We sought to evaluate the impact of needle core size and number of core samples on diagnostic accuracy and upgrade rates for image-guided core needle biopsies of the breast. A total of 234 patients underwent image-guided percutaneous needle biopsies and subsequent surgical excision. Large-core needles (9 gauge or less) were used in 14.5 per cent of cases and the remainder were performed with smaller core needles. More than four core samples were taken in 78.9 per cent of patients. In 71.8 per cent of cases, needle biopsy pathology matched surgical excision pathology. After surgical excision, upgraded pathology was revealed in 10.7 per cent of cases. Of 11 patients (52.4%) with benign needle core pathology who had upgraded final pathology on surgical excision, 10 had a Breast Imaging Recording and Data System score 4 or 5 imaging study. Lesions smaller than 10 mm were more likely to be misdiagnosed ( P = 0.01) or have upgraded pathology ( P = 0.009). Other predictors of upgraded pathology were patient age 50 years or older ( P = 0.03) and taking four or fewer core samples ( P = 0.003). Needle core size did not impact accuracy or upgrade rates. Surgeons should exercise caution when interpreting needle biopsy results with older patients, smaller lesions, and limited sampling. Discordant pathology and imaging still mandate surgical confirmation.

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Breast ultrasound: recommendations for information to women and referring physicians by the European Society of Breast Imaging

Insights into Imaging ◽

10.1007/s13244-018-0636-z ◽

2018 ◽

Vol 9 (4) ◽

pp. 449-461 ◽

Cited By ~ 18

Author(s):

Andrew Evans ◽

◽

Rubina M. Trimboli ◽

Alexandra Athanasiou ◽

Corinne Balleyguier ◽

...

Keyword(s):

European Society ◽

Breast Imaging ◽

Breast Ultrasound ◽

Referring Physicians

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Optimizing the Patient Experience during Breast Biopsy

Journal of Breast Imaging ◽

10.1093/jbi/wbz001 ◽

2019 ◽

Vol 1 (2) ◽

pp. 131-138 ◽

Cited By ~ 3

Author(s):

Mary Scott Soo ◽

Rebecca A Shelby ◽

Karen S Johnson

Keyword(s):

Patient Satisfaction ◽

Patient Experience ◽

Breast Imaging ◽

Breast Biopsy ◽

Patient Communication ◽

Patient Perspectives ◽

Core Needle ◽

Image Guided ◽

Family Centered ◽

Patient Concerns

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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Image-Guided Procedure Versus 2-year Follow-up for a BI-RADS 3 Probably Benign Lesion: A Cost Comparison Analysis

Journal of Breast Imaging ◽

10.1093/jbi/wbaa087 ◽

2020 ◽

Author(s):

Andrew Ong ◽

Armina Azizi ◽

Emily B Ambinder ◽

Eniola T Oluyemi ◽

Susan C Harvey ◽

...

Keyword(s):

Breast Imaging ◽

Breast Biopsy ◽

Breast Mri ◽

Cost Comparison ◽

Average Risk ◽

Risk Population ◽

Image Guided ◽

Mri Guided ◽

Benign Biopsy

Abstract Objective Perform a comparison between the costs of image-guided breast procedures versus 2-year imaging follow-up for findings classified as BI-RADS does not need to be expanded in the abstract BI-RADS assessment category 3-probably benign. Methods The national payment amount costs at non-facility locations were obtained from the Centers for Medicare and Medicaid Services physician fee schedule for breast imaging-related Current Procedural Terminology codes. Total costs were calculated and compared for management algorithms of 2-year imaging follow-up of a BI-RADS 3 lesion from 2018 through 2019 versus performing an image-guided procedure of the lesion in 2018 after the initial diagnostic imaging. Results Two-year mammographic follow-up of a BI-RADS 3 finding costs $484. This was less than a stereotactic-guided breast biopsy, which cost at least $1055. Two-year follow-up for a probably benign ultrasound does not need to be expanded in JBI US finding cost $615 compared to $1173 for the least expensive US-guided breast biopsy scenario. For breast MRI, 2-year imaging follow-up cost $1510, which was also less than most MRI-guided breast biopsy scenarios. The one exception in which biopsy costs less than 2-year imaging follow-up was in the setting of an MRI-guided biopsy in the average-risk population without a post-benign biopsy follow-up breast MRI; in this setting, MRI biopsy cost $1235. Conclusion In 2018–2019, 2-year imaging follow-up of a BI-RADS 3 finding continues to be less costly than an immediate procedure, except for MRI-guided breast biopsy in the average-risk population without a post-benign biopsy follow-up MRI.

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Understanding Patient Anxiety and Pain During Initial Image-guided Breast Biopsy

Journal of Breast Imaging ◽

10.1093/jbi/wbaa072 ◽

2020 ◽

Vol 2 (6) ◽

pp. 583-589

Author(s):

Santo Maimone ◽

Andrey P Morozov ◽

Annamaria Wilhelm ◽

Inna Robrahn ◽

Tedra D Whitcomb ◽

...

Keyword(s):

Breast Biopsy ◽

Procedural Pain ◽

Patient Anxiety ◽

Initial Image ◽

Image Guided ◽

Pain Scores ◽

Multiple Biopsies ◽

Lower Pain ◽

Malignant Lesions ◽

Positive Correlations

Abstract Objective Image-guided breast biopsies are safe, efficient, and reliable. However, patients are often anxious about these procedures, particularly those who have never undergone a prior biopsy. Methods This prospective IRB-approved study surveyed 163 patients undergoing their first breast biopsy. Participants provided informed consent and completed a short written survey prior to and immediately after their procedure. Level of anxiety as well as anticipated and actual levels of pain prior to and following the procedure were assessed using a 0–10-point Likert scale. Correlation, bivariate, and regression analyses were performed. Results Regarding the biopsy experience, 133/163 (81.6%) of patients reported it as better than expected. Anxiety decreased significantly from a prebiopsy mean score of 5.52 to a postbiopsy mean score of 2.25 (P < 0.001). Average and greatest pain experienced during the procedure had mean scores of 2.03 and 2.77, respectively, both significantly lower compared to preprocedural expectation (mean 4.53) (P < 0.001). Lower pain scores were reported in US-guided procedures compared to stereotactic- and MRI-guided biopsies (P < 0.001). No significant differences in pain scores were seen in those undergoing single versus multiple biopsies, or when benign, elevated-risk, or malignant lesions were sampled. Positive correlations were seen with prebiopsy anxiety levels and procedural pain as well as with anticipated pain and actual procedural pain. Conclusion Image-guided biopsies are often better tolerated by patients than anticipated. We stress the benefit of conveying this information to patients prior to biopsy, as decreased anxiety correlates with lower levels of pain experienced during the procedure.

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Intraductal Papilloma Without Atypia on Image- Guided Breast Biopsy: Upgrade Rates to Carcinoma at Surgical Excision

Breast Care ◽

10.1159/000489096 ◽

2018 ◽

Vol 13 (5) ◽

pp. 364-368 ◽

Cited By ~ 4

Author(s):

Doris Leithner ◽

Benjamin Kaltenbach ◽

Petra Hödl ◽

Volker Möbus ◽

Volker Brandenbusch ◽

...

Keyword(s):

Needle Biopsy ◽

Breast Biopsy ◽

Ductal Carcinoma ◽

Statistical Tests ◽

Menopausal Status ◽

Surgical Excision ◽

Lesion Size ◽

Intraductal Papilloma ◽

Image Guided ◽

Institutional Review

Background: The management of intraductal papilloma without atypia (IDP) in breast needle biopsy remains controversial. This study investigates the upgrade rate of IDP to carcinoma and clinical and radiologic features predictive of an upgrade. Methods: Patients with a diagnosis of IDP on image-guided (mammography, ultrasound, magnetic resonance imaging) core needle or vacuum-assisted biopsy and surgical excision of this lesion at a certified breast center between 2007 and 2017 were included in this institutional review board-approved retrospective study. Appropriate statistical tests were performed to assess clinical and radiologic characteristics associated with an upgrade to malignancy at excision. Results: For 60 women with 62 surgically removed IDPs, the upgrade rate to malignancy was 16.1% (10 upgrades, 4 invasive ductal carcinoma, 6 ductal carcinoma in situ). IDPs with upgrade to carcinoma showed a significantly greater distance to the nipple (63.5 vs. 36.8 mm; p = 0.012). No significant associations were found between upgrade to carcinoma and age, menopausal status, lesion size, microcalcifications, BI-RADS descriptors, initial BI-RADS category, and biopsy modality. Conclusion: The upgrade rate at excision for IDPs diagnosed with needle biopsy was higher than expected according to some guideline recommendations. Observation only might not be appropriate for all patients with IDP, particularly for those with peripheral IDP.

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