Ultrasound-Guided Breast Biopsies: Basic and New Techniques

A Low-Cost Optomechatronic Diffuse Optical Mammography System for 3D Image Reconstruction: Proof of Concept

Background: The development and initial testing of an optomechatronic system for the reconstruction of three-dimensional (3D) images to identify abnormalities in breast tissue and assist in the diagnosis of breast cancer is presented. Methods: This system combines 3D reconstruction technology with diffuse optical mammography (DOM) to offer a detecting tool that complements and assists medical diagnosis. DOM analyzes tissue properties with light, detecting density and composition variations. Integrating 3D reconstruction enables detailed visualization for precise tumor localization and sizing, offering more information than traditional methods. This technological combination enables more accurate, earlier diagnoses and helps plan effective treatments by understanding the patient's anatomy and tumor location. Results: Using Chinese ink, it was possible to identify simulated abnormalities of 10, 15, and 20 mm in diameter in breast tissue phantoms from cosmetic surgery. Conclusions: Data can be processed using algorithms to generate three-dimensional images, providing a non-invasive and safe approach for detecting anomalies. Currently, the system is in a pilot testing phase using breast tissue phantoms, enabling the evaluation of its accuracy and functionality before application in clinical studies.

EURO-MUSCULUS/USPRM phantom recipe for (musculoskeletal) interventional ultrasound training

Considering the growing role of ultrasound-guided procedures in musculoskeletal medicine, training as regards these interventions is pivotal. While hands-on training on cadavers can be considered optimal, it has several drawbacks, e.g., high cost, poor availability, and technical challenges regarding preservation. Apart from cadavers, different approaches to practicing needle guidance are taught in ultrasound workshops whereby phantoms from meat (e.g., chicken breast), cheese or gelatin are used. Likewise, this article aims to provide a detailed description as to how different gelatin-based phantoms can be prepared. In line with the EURO-MUSCULUS/USPRM (European Musculoskeletal Ultrasound Study Group/Ultrasound Study Group of the International Society of Physical and Rehabilitation Medicine) protocols/background, the authors describe particular basic and advanced phantoms to be used for practicing different technical/manual skills pertaining to common ultrasound-guided procedures. The present manuscript can be considered a practical and ready-to-use "recipe book" for readers who are interested in the wide spectrum of interventional ultrasound.

Breast Biopsy Procedure Toolkit: Ultrasound, 2D Stereotactic, 3D Tomosynthesis, and MRI-Guided Procedures

This article explores various techniques and tips for performing successful percutaneous biopsies of the breast and axillary lymph nodes using different imaging modalities. The discussion includes detailed image guidance on ultrasound-guided, stereotactic/tomosynthesis-guided, and MRI-guided biopsies. Advice for draining fluid collections in the breast is also reviewed. Key findings include the comparative effectiveness of different imaging techniques and practical advice for improving procedural outcomes. This information is particularly relevant for radiologists involved in diagnostic and interventional breast care. Recommendations for optimizing biopsy procedures and managing complications are also presented.

Feasibility and Accuracy of Ultrasound-Guided Core Needle Biopsy for Nipple Lesions: A Pilot Study

BACKGROUND

Due to the superficial location, suspicious findings of the nipple-areolar complex (NAC) are not amenable to stereotactic or MRI-guided sampling and have historically necessitated surgical biopsy or skin-punch biopsy. There are limited reports of US-guided core biopsy of the nipple (US-CBN).

OBJECTIVE

We report our nearly 3-year pilot experience with US-CBN at an academic breast imaging center.

METHODS

An institutional review board-exempt and HIPAA-compliant retrospective review was performed. We assessed patient demographics, breast imaging characteristics, procedural data, pathology, and outcomes.

RESULTS

Nine female patients aged 27 to 64 underwent US-CBN from January 2021 to October 2023. Initial imaging abnormalities included abnormal MRI enhancement, mammographic calcifications, and sonographic masses. After initial or second-look US, all imaging findings had sonographic correlates for biopsy specimens, the majority of which were sonographic masses (8/9). US-CBN was performed by 6 breast radiologists using a variety of devices. All biopsy specimen results were concordant with sonographic abnormalities, although 1 was considered discordant from the initial abnormality seen on MRI. There were no complications, and discomfort during the procedure was well-treated. Two patients (22%, 2/9) were diagnosed with malignancy.

CONCLUSION

This pilot study demonstrated that US-CBN can be performed by a breast radiologist for definitive diagnosis of suspicious nipple abnormalities seen on breast imaging, avoiding surgery, and maintaining nipple integrity. In our population, 22% (2/9) of US-CBNs revealed malignancy.

Applicability of Quantum Dots in Breast Cancer Diagnostic and Therapeutic Modalities-A State-of-the-Art Review

The increasing incidence of breast cancers (BCs) in the world population and their complexity and high metastatic ability are serious concerns for healthcare systems. Despite the significant progress in medicine made in recent decades, the efficient treatment of invasive cancers still remains challenging. Chemotherapy, a fundamental systemic treatment method, is burdened with severe adverse effects, with efficacy limited by resistance development and risk of disease recurrence. Also, current diagnostic methods have certain drawbacks, attracting attention to the idea of developing novel, more sensitive detection and therapeutic modalities. It seems the solution for these issues can be provided by nanotechnology. Particularly, quantum dots (QDs) have been extensively evaluated as potential targeted drug delivery vehicles and, simultaneously, sensing and bioimaging probes. These fluorescent nanoparticles offer unlimited possibilities of surface modifications, allowing for the attachment of biomolecules, such as antibodies or proteins, and drug molecules, among others. In this work, we discuss the potential applicability of QDs in breast cancer diagnostics and treatment in light of the current knowledge. We begin with introducing the molecular and histopathological features of BCs, standard therapeutic regimens, and current diagnostic methods. Further, the features of QDs, along with their uptake, biodistribution patterns, and cytotoxicity, are described. Based on the reports published in recent years, we present the progress in research on possible QD use in improving BC diagnostics and treatment efficacy as chemotherapeutic delivery vehicles and photosensitizing agents, along with the stages of their development. We also address limitations and open questions regarding this topic.

Evaluating the Role of Breast Ultrasound in Early Detection of Breast Cancer in Low- and Middle-Income Countries: A Comprehensive Narrative Review

Breast cancer, affecting both genders, but mostly females, exhibits shifting demographic patterns, with an increasing incidence in younger age groups. Early identification through mammography, clinical examinations, and breast self-exams enhances treatment efficacy, but challenges persist in low- and medium-income countries due to limited imaging resources. This review assesses the feasibility of employing breast ultrasound as the primary breast cancer screening method, particularly in resource-constrained regions. Following the PRISMA guidelines, this study examines 52 publications from the last five years. Breast ultrasound, distinct from mammography, offers advantages like radiation-free imaging, suitability for repeated screenings, and preference for younger populations. Real-time imaging and dense breast tissue evaluation enhance sensitivity, accessibility, and cost-effectiveness. However, limitations include reduced specificity, operator dependence, and challenges in detecting microcalcifications. Automatic breast ultrasound (ABUS) addresses some issues but faces constraints like potential inaccuracies and limited microcalcification detection. The analysis underscores the need for a comprehensive approach to breast cancer screening, emphasizing international collaboration and addressing limitations, especially in resource-constrained settings. Despite advancements, notably with ABUS, the primary goal is to contribute insights for optimizing breast cancer screening globally, improving outcomes, and mitigating the impact of this debilitating disease.

Vacuum-assisted biopsy system for breast lesions: a potential therapeutic approach

Purpose

The primary objective is to optimize the population eligible for Mammotome Minimally Invasive Surgery (MIS) by refining selection criteria. This involves maximizing procedure benefits, minimizing malignancy risk, and reducing the rate of malignant outcomes.

Patients and methods

A total of 1158 female patients who came to our hospital from November 2016 to August 2021 for the Mammotome MIS were analyzed retrospectively. Following χ2 tests to screen for risk variables, binary logistic regression analysis was used to determine the independent predictors of malignant lesions. In addition, the correlation between age and lesion diameter was investigated for BI-RADS ultrasound (US) category 4a lesions in order to better understand the relationship between these variables.

Results

The malignancy rates of BI-RADS US category 3, category 4a and category 4b patients who underwent the Mammotome MIS were 0.6% (9/1562), 6.4% (37/578) and 8.3% (2/24) respectively. Malignant lesions were more common in patients over the age of 40, have visible blood supply, and BI-RADS category 4 of mammography. In BI-RADS US category 4a lesions, the diameter of malignant tumor was highly correlated with age, and this correlation was strengthened in patients over the age of 40 and with BI-RADS category 4 of mammography.

Conclusion

The results of this study demonstrate that the clinical data and imaging results, particularly age, blood supply, and mammography classification, offer valuable insights to optimize patients' surgical options and decrease the incidence of malignant outcomes.

pH-responsive ratiometric photoacoustic imaging of polyaniline nanoparticle-coated needle for targeted cancer biopsy

Cancer microenvironment exhibits lower pH compared to healthy tissues, a characteristic which can be exploited using a pH-responsive needle to increase the accuracy of cancer biopsy. A needle, coated with pH-responsive polyaniline (PANI) nanoparticles (PANI-needle), is developed for the minimally invasive and quantitative pH analysis of tissue based on ratiometric photoacoustic (PA) imaging. The ratiometric PA signal from the PANI-needle within the 850-700 nm wavelength range shows a linear response as pH changes from 7.5 to 6.5. Owing to the high surface area of nanostructured PANI, the PA signal of PANI-needle exhibits a fast and reversible response of less than a few seconds. In a tissue-mimicking hydrogel phantom composed of two regions with different pH, PA ratios of PANI-needle successfully differentiate the local pH. The PANI-needle coupled with ultrasound-guided PA imaging is a promising technology for detection of malignant tissue through quantitative pH analysis during needle biopsy.

Learning curve in ultrasound-guided vacuum-assisted excision of breast lesions for surgeons and ultrasound physicians

Background

The varying experience of surgeons and ultrasound physicians, and their collaboration with physicians, may affect operation time and efficiency. We evaluated the learning curve of ultrasound-guided vacuum-assisted excision (VAE) of breast lesion with collaboration between different physicians, and assessed characteristics associated with operation time.

Methods

The sample population of this retrospective study was divided into two groups: 49 consecutive patient surgeries completed by skilled surgeons and novice ultrasound physicians (U group); and 30 consecutive patient surgeries completed by skilled ultrasound physicians and novice surgeons (S group). Cumulative summation graphs were used to evaluate operation time and calculate the turning point of the learning curve. Patients in the U and S groups were divided into exploration stage and proficiency stage according to the turning point, and the differences in influencing factors were compared. A total of 548 patients who underwent vacuum-assisted breast excision performed by a combination of skilled surgeons and skilled ultrasound physicians were selected as the reference group (R group). The differences among the three groups were compared. The relationship between the operation time and other factors in the different groups was analyzed using linear regression.

Results

The best learning curve of the sample population was the quadratic fitting equation, and the turning point was the 19th case in the U group and the 14th case in the S group. The total operation times in the proficiency stage were significantly shorter than those in the exploration stage in the U and S groups (P=0.012 and P=0.003, separately). Patient age, long diameter, short diameter, and depth of masses related to the operation time.

Conclusions

Our data suggest the existence of different learning curves in ultrasound-guided vacuum-assisted excision for the collaborations of different stages surgeons and ultrasound physicians. Through the accumulation of experience, it is feasible to safely perform ultrasound-guided VAE of breast lesions.

High-Risk Breast Lesions Diagnosed by Ultrasound-Guided Vacuum-Assisted Excision

PURPOSE

The aim of this study was to analyze the role of ultrasound-guided vacuum-assisted excision (US-guided VAE) in the treatment of high-risk breast lesions and to evaluate the clinical and US features of the patients associated with recurrence or development of malignancy.

MATERIALS AND METHODS

Between April 2010 and September 2021, 73 lesions of 73 patients underwent US-guided VAE and were diagnosed with high-risk breast lesions. The incidence of recurrence or development of malignancy for high-risk breast lesions was evaluated at follow-up period. The clinical and US features of the patients were analyzed to identify the factors affecting the recurrence or development of malignancy rate.

RESULTS

Only benign phyllodes tumors on US-guided VAE showed recurrences, while other high-risk breast lesions that were atypical ductal hyperplasia (ADH), lobular neoplasia (atypical lobular hyperplasia/lobular carcinoma in situ), radial scar, and flat epithelial atypia did not show recurrences or malignant transformation. The recurrence rate of the benign phyllodes tumor was 20.8% (5/24) in a mean follow-up period of 34.3 months. The recurrence rate of benign phyllodes tumor with distance from nipple of less than 1 cm was significantly higher than that of lesions with distance from nipple of more than 1 cm (75% vs. 10%, p < 0.05).

CONCLUSIONS

Benign phyllodes tumors without concurrent breast cancer could be safely followed up instead of surgical excision after US-guided VAE when the lesions were classified as BI-RADS 3 or 4A by US.

Augmented Reality-Assisted Ultrasound Breast Biopsy

Breast cancer is the most prevalent cancer in the world and the fifth-leading cause of cancer-related death. Treatment is effective in the early stages. Thus, a need to screen considerable portions of the population is crucial. When the screening procedure uncovers a suspect lesion, a biopsy is performed to assess its potential for malignancy. This procedure is usually performed using real-time Ultrasound (US) imaging. This work proposes a visualization system for US breast biopsy. It consists of an application running on AR glasses that interact with a computer application. The AR glasses track the position of QR codes mounted on an US probe and a biopsy needle. US images are shown in the user's field of view with enhanced lesion visualization and needle trajectory. To validate the system, latency of the transmission of US images was evaluated. Usability assessment compared our proposed prototype with a traditional approach with different users. It showed that needle alignment was more precise, with 92.67 ± 2.32° in our prototype versus 89.99 ± 37.49° in a traditional system. The users also reached the lesion more accurately. Overall, the proposed solution presents promising results, and the use of AR glasses as a tracking and visualization device exhibited good performance.

The added value of S-detect in the diagnostic accuracy of breast masses by senior and junior radiologist groups: a systematic review and meta-analysis

Background

S-detect is an emerging computer-aided diagnosis (CAD) technique that provides a reference for radiologists to identify breast cancer. Some studies have shown that US (ultrasound) + S-detect can improve the diagnostic accuracy of junior radiologists more than senior radiologists, but the results are inconsistent in various studies. Therefore, this meta-analysis aimed to assess the value of S-detect combined with the US outcomes from senior and junior radiologists for the diagnosis of breast cancer.

Methods

We searched the PubMed, Cochrane Library, Embase, Web of Science, and Wanfang databases, China Biology Medicine disc, China National Knowledge Infrastructure (CNKI), and VIP database for trials on the diagnostic accuracy of US + S-detect for the diagnosis of breast masses. The search time frame was from the date of establishment of the database to August 20, 2022. Two researchers independently screened the literature, extracted the information, and evaluated the quality of the included literature using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) scale. StataSE 15.1 software was utilized to assess pooled metrics, including sensitivity, specificity, and the area under the curve (AUC).

Results

A total of 19 articles with 3,349 patients and 3,895 breast masses were included in this meta-analysis. Of these, seventeen articles evaluated the diagnostic performance of senior radiologists' US + S-detect for breast cancer, while twelve articles reported junior radiologists' diagnostic performance. The risk of bias was primarily attributed to patient selection, flow and timing. In the senior radiologist group, the pooled sensitivity and specificity of US + S-detect were 0.93 [95% confidence interval (CI): 0.89-0.95] and 0.86 (95% CI: 0.80-0.90), respectively, with an AUC of 0.96. As for the junior radiologist group, the pooled sensitivity and specificity of US + S-detect were 0.89 (95% CI: 0.83-0.93) and 0.79 (95% CI: 0.72-0.84), respectively, and the AUC was 0.91.

Conclusions

The results of this meta-analysis showed that the pooled sensitivity and the AUC of both the senior and junior radiologist groups were high, with good diagnostic efficacy and high clinical application. However, the results of this study are highly heterogeneous and need to be validated by collecting more high-quality studies and accumulating a larger sample size.

Breast Cancer—How Can Imaging Help?

Breast cancer is the most common malignant disease among women, causing death and suffering worldwide. It is known that, for the improvement of the survival rate and the psychological impact it has on patients, early detection is crucial. For this to happen, the imaging techniques should be used at their full potential. We selected and examined 44 articles that had as subject the use of a specific imaging method in breast cancer management (mammography, ultrasound, MRI, ultrasound-guided biopsy, PET-CT). After analyzing their data, we summarized and concluded which are the best ways to use each one of the mentioned techniques for a good outcome. We created a simplified algorithm with easy steps that can be followed by radiologists when facing this type of neoplasia.

Application value of a new lesion positioning stickers in breast lesion surface localization

OBJECTIVES

Accurate breast lesion surface localization can guarantee accurate biopsy and local treatment. But there is no guideline to regular equipment and methods for the localization of breast lesions. The conventional non-invasive localization method is marker-based localization. The advantages of this method are simple and efficient. The disadvantages are that markers disappear easily under coupling agents; the positioning length of markers cannot last long on skin; and healthcare associated infection due to many patients using the same marker pen is potentially unavoidable. Breast lesion sticker (called sticker for short) is a new-type localization medical instrument in 2020. Our study aims to explore the clinical value of a new lesion stickers in breast lesion surface localization via comparison of the sticker and marker pen localization methods.

METHODS

This was a prospective cohort study. It was conducted in 67 patients who needed breast lesion surface localization before biopsy. The patients were randomly assigned into 2 groups. One group of patients used marker pen to mark breast lesion surface location by ultrasonography. The other group of patients used stickers. Patients labeled with markers on skin were swabbed agents before marking. Then the markers were checked by ultrasound scan. If the surface positions of breast lesion were not correct, the above procedure was repeated. In the sticker group, the stickers were released synchronously after the lesions were detected by ultrasound scan. Then locations were checked via scanning hole. If the surface positions of breast lesion were not correct, the above procedure was repeated. The accuracy of positioning, the length of positioning time and satisfaction of patients between the 2 groups were compared. The length of positioning time was calculated from the time when ultrasound detected the lesion to the time when the surface position of breast lesion was confirmed. The total score of patients' satisfaction was 5 points according to Service Quality Evaluation of SERVQUAL Scale, including sonographers' service attitude and their technical proficiency, other medical staffs' service attitude and their technical proficiency, hospital service procedures, positioning comfort, and positioning effects.

RESULTS

All 67 patients were females, aged 18-66 (39.73±13.10). There were 35 patients in the marker pen group and 32 patients in the sticker group. The time length of group used marker pen to localization was 22-88 (52.20±2.90) s, and the sticker group was 3-15 (9.22±0.58) s in length. The length of positioning time for the stickers was significantly shorter than that of the marker (P<0.01). Both methods were accurate in the surface localization of lesions before operation. The total scores of patients' satisfaction was 4-5 (4.92±0.02) in the stickers group, and 1-5 (3.35±0.10) in the marker pen group. The patients' satisfaction scores with the sticker were significantly higher than those with the marker pen (P<0.01). The length of positioning time and patients' satisfication scores for sonographer with 20 years' working experience were shorter and higher than those of sonographer with 10 years' working experience, respectively (both P<0.05).

CONCLUSIONS

The new breast lesion positioning stickers have more advantages than the marker pen in localization efficiency. It could reduce the workload of medical workers and increase patients' satisfaction to some extent. The stickers can be used not only in the breast lesions surface localization, but also in the skin location of pleural effusion and ascites, the skin location of surface masses, the skin location of thyroid nodule, and many other clinical marker areas, to further expand the scope of clinical application and value of the stickers.

Traumatic neuroma at the mastectomy site, unusual benign lesion, mimicking tumor recurrence: A report of two cases

Traumatic neuroma is not a true neoplasm but a reparative proliferation of axons, Schwann cells, and fibroblasts at the proximal end of transected or injured nerves resulting from trauma or surgery. Breast traumatic neuroma after breast surgery, with or without clinical symptoms, has rarely been reported. Once found, it should be differentiated from tumor recurrence, and tissue confirmation is necessary, although it is small in size and demonstrates a benign appearance in imaging studies. Herein, we present two cases of traumatic neuroma at the mastectomy site. They were incidentally encountered during ultrasound evaluation of mastectomy beds given concerns for potential recurrence or malignancy, and pathologic confirmation by ultrasound-guided core needle biopsy was sufficient for the diagnosis.