Advances in Ultrasound-Guided Vacuum-Assisted Biopsy of Breast Microcalcifications

Ultrasound versus computed tomography guided percutaneous needle biopsy for subpleural pulmonary lesions

Background

Sub-pleural pulmonary lesions (SPLs) can be diagnosed by percutaneous needle biopsy (PNB) guided by both computed tomography (CT) and ultrasound (US). This investigation aims to compare the diagnostic accuracy and safety between US- and CT-guided PNB for SPLs.

Methods

This retrospective study analyzed SPL patients who underwent CT- or US-guided PNB in our hospital between January 2022 to January 2023. Furthermore, the technical success rates, duration of procedure, diagnostic yield, diagnostic accuracy, pneumothorax rates, and hemoptysis rates were compared between the 2 groups. Pneumothorax risk factors were assessed via the univariate and multivariate logistic regression tests.

Results

The data indicated that 213 patients who underwent CT- (n = 108) or US-guided (n = 105) PNB diagnosis had SPLs at the final diagnosis. Furthermore, both groups indicated similar operation times (20.1 ± 8.1 min vs. 19.9 ± 6.9 min, p = 0.793). The diagnostic accuracy and yield of the US group were 100% and 64.8%, respectively, whereas those of the CT group were 99.1% and 72.2%, respectively. Moreover, no significant differences were observed in diagnostic accuracy (p = 1.000) and diagnostic yield (p = 0.561) between the 2 groups. The CT group indicated markedly higher rates of chest tube insertion (6.5% vs. 0.0%, p = 0.014) and pneumothorax (24.1% vs. 1.9%, p = 0.001) than the US group. However, the hemoptysis rates were comparable between the 2 groups (2.7% vs. 2.9%, p = 1.000). In addition, CT guidance was the independent risk factor of pneumothorax (p = 0.003).

Conclusions

In summary, this research indicated that both US- and CT-guided PNB have high diagnostic accuracy for SPLs. However, US guidance may provide better safety than CT guidance.

Predicting Non-Mass Breast Cancer Utilizing Ultrasound and Molybdenum Target X-Ray Characteristics

Objective

The aim of this study is to investigate the influence of ultrasound and molybdenum target X-ray characteristics in predicting non-mass breast cancer.

Methods

A retrospective analysis was conducted on the clinical data of 185 patients presenting with non-mass breast lesions between September 2019 and 2021. The non-mass lesions were categorized into benign and malignant types based on ultrasonographic findings, which included lamellar hypoechoic, ductal alteration, microcalcification, and structural disorder types. Furthermore, an examination was undertaken to discern variances in molybdenum target X-ray parameters, ultrasonographic manifestations, and characteristics among individuals diagnosed with non-mass breast lesions.

Results

The ultrasonographic depiction of microcalcified lesions and the identification of suspicious malignancy through molybdenum target X-ray evaluation exhibited independent associations with non-mass breast cancer, yielding statistically significant differences (p < 0.05). Subsequently, the logistic regression model was formulated as follows: Logit (P) =-1.757+2.194* microcalcification type on ultrasound + 1.520* suspicious malignancy on molybdenum target X-ray evaluation. The respective areas under the receiver operating characteristic curves for microcalcification type on ultrasound, suspicious malignancy on molybdenum target X-ray, and the integrated diagnostic model were 0.733, 0.667, and 0.827, respectively, demonstrating discriminative capacities.

Conclusion

Using both ultrasound and molybdenum target X-ray diagnostics can increase the accuracy of non-mass breast cancer detection. The findings of this study have the potential to augment the detection rate of non-lumpy breast cancer and provide an imaging basis for enhancing the prognosis of individuals with breast cancer.

Performance of ultrasound guidance for vacuum-assisted biopsy of breast microcalcifications without associated mass

•The accuracy of ultrasound (US)-guided biopsies of suspicious microcalcifications without mass is similar, or even better than results published in literature with stereotactic-guided biopsies.•When the microcalcifications are visible on ultrasound, there is no loss of chance in performing the biopsy under ultrasound guidance rather than under stereotactic guidance.•US guidance allows access to difficult areas for stereotactic, increases the comfort of the patient, avoids compression and irradiation.

Multilevel predictors of guideline concordant needle biopsy use for non-metastatic breast cancer

PURPOSE

Persistent breast cancer disparities, particularly geographic disparities, may be explained by diagnostic practice patterns such as utilization of needle biopsy, a National Quality Forum-endorsed quality metric for breast cancer diagnosis. Our objective was to assess the relationship between patient- and facility-level factors and needle biopsy receipt among women with non-metastatic breast cancer in the United States.

METHODS

We examined characteristics of women diagnosed with breast cancer between 2004 and 2015 in the National Cancer Database. We assessed the relationship between patient- (e.g., race/ethnicity, stage, age, rurality) and facility-level (e.g., facility type, breast cancer case volume) factors with needle biopsy utilization via a mixed effects logistic regression model controlling for clustering by facility.

RESULTS

In our cohort of 992,209 patients, 82.96% received needle biopsy. In adjusted models, the odds of needle biopsy receipt were higher for Hispanic (OR 1.04, Confidence Interval 1.01-1.08) and Medicaid patients (OR 1.04, CI 1.02-1.08), and for patients receiving care at Integrated Network Cancer Programs (OR 1.21, CI 1.02-1.43). Odds of needle biopsy receipt were lower for non-metropolitan patients (OR 0.93, CI 0.90-0.96), patients with cancer stage 0 or I (at least OR 0.89, CI 0.86-0.91), patients with comorbidities (OR 0.93, CI 0.91-0.94), and for patients receiving care at Community Cancer Programs (OR 0.84, CI 0.74-0.96).

CONCLUSION

This study suggests a need to account for sociodemographic factors including rurality as predictors of utilization of evidence-based diagnostic testing, such as needle biopsy. Addressing inequities in breast cancer diagnosis quality may help improve breast cancer outcomes in underserved patients.