Ultrasound-guided Breast Biopsy Research Articles

14 ve 18 Gauge İğnelerle Yapılan Kor İğne Meme Biyopsisi Analizlerinin Değerlendirilmesi: Sekiz Yıllık Tek Merkez Deneyimi

Aim: Percutaneous imaging-guided core needle breast biopsy has become widely used as an alternative to incisional biopsy in the diagnosis of breast lesions. In this study, it was aimed to evaluate and report our core needle breast biopsy experiences performed with 14- and 18-gauge needles. Material and Methods: Patients who underwent core needle breast biopsy between March 2012 and December 2019 in our radiology department and whose biopsy specimens were evaluated in the pathology department, of all age groups and both sexes, were included in this study. A total of 628 (615 female and 13 male) patients with breast masses were examined. Results: The mean age of the patients was 52.20±13.94 (median= 51, range, 13-96) years, 90.4% (n=568) of the lesions were masses and the majority of lesions (53.2%, n=334) were 11-20 mm in size. The most of cases (47.2%, n=268) were BI-RADS 5. There was no significant difference between the two needles in terms of gender distribution, age, type of surgery, and core needle breast biopsy results. In 86.5% (n=141) of the patients, there was diagnostic accuracy between the surgical specimen and the core needle breast biopsy result. Conclusion: We demonstrated that the 14-gauge and 18-gauge needles have similar performance of results. Smaller needles should be used for ultrasound-guided breast biopsies, which is less invasive, less painful, and creates less risk of hemorrhage. Moreover, no patient admitted to the emergency department because of the core needle breast biopsy acute complications such as hematoma, bleeding, etc. during this time.

Wireless ultrasound-guided vacuum-assisted breast biopsy: Experience in clinical practice at European Institute of Oncology.

In the last few years, ultrasound-guided vacuum-assisted breast biopsy (US-VABB) has replaced surgical biopsy due to higher diagnostic accuracy and lower patient discomfort, and, at present, an even greater possibility is represented by the new wireless ultrasound-guided VAB device (Wi-UVAB). The purpose of our study is to determine the diagnostic accuracy of this new device in a sizeable representative number of patients. From January 2014 to June 2018, 168 biopsies were performed in our institution using the new Wi-UVAB device. We analyzed sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of biopsies obtained with the new device using surgical results as reference point, following patients for at least one year. In our cohort, we obtained a complete sensitivity of 97.5%, an absolute sensitivity of 94.3%, a complete specificity of 98%, and an absolute specificity of 98%. The positive predictive value of the procedure was 97.5% while the negative predictive value was 98%. The diagnostic accuracy was 98%. The Wi-UVAB is a safe procedure with high diagnostic accuracy, comparable to that of the traditional vacuum-assisted breast biopsy and even higher than that of core needle biopsy (CNB). Moreover, the Wi-UVAB is easy to use and shows low costs as core needle biopsy (CNB).

Abstract PS3-27: 18F-FDG-PET/CT and MRI in the assessment of neoadjuvant chemotherapy treatment response in breast cancer. Correlation with pathological response

Abstract Introduction: Residual cancer burden (RCB) after neoadjuvant chemotherapy (NAC) can accurately predict disease recurrence and survival in breast cancer. In this context, end of treatment (EOT) image-guided response assessment could be useful to adapt treatment for individual patients. Our main objective was to assess the effectiveness of 18F-FDG PET/CT and MRI in determining NAC response. Methods: Patients with surgically resectable breast cancer (stages II-III) were prospectively included and evaluated with 18F-FDG-PET/CT and MRI before and after standard-of-care neoadjuvant chemotherapy (NAC). Ultrasound guided breast biopsy was performed before NAC and pathologic examination with residual cancer burden (RCB) scoring was performed after surgery. Standard uptake values (SUVmax and SUVmean) from baseline PET scans were measured. EOT images results were compared with RCB scores to assess the sensitivity and specificity of (EOT) 18F-FDG-PET/CT and MRI images. A multinomial logistic regression was performed to assess predictors of pathological response. A p-value of 0.05 was considered significant. Results: 30 patients were included, with 25% showing complete pathological response. EOT 18F-FDG-PET/CT images had a sensitivity of 55% and specificity of 100% to predict RCB > 0, while EOT MRI had a sensitivity of 65% and specificity of 66,6%. Luminal tumors showed significant lower baseline SUVmean and SUVmax values than triple-negative tumors. Ki67 expression didn´t correlate with treatment outcome. High estrogen receptor expression level was significantly associated with non-complete pathological response and higher false negative rates in both EOT 18F-FDG-PET and MRI images (7/8 in PET and 6/7 in MRI). Conclusions: 18F-FDG-PET / CT could be a useful diagnostic tool to assess neoadjuvant chemotherapy treatment response in breast cancer, showing greater specificity than MRI to predict pathological response. A high expression of estrogen receptors could lead to a high rate of false negative findings, both in PET and MRI. A greater number of cases is required to validate these findings. Citation Format: Marco Guarin, M. Eugenia Azar, Carolina Tinetti, M. Dolores Mansilla F., Mauro Namias, Pilar Carballo, Lucia Santamarina, Jorgelina Cavallero, Romina Moreau, Christian Gonzalez, Valeria Caceres, Eduardo Gonzalez, Gabriel Bruno. 18F-FDG-PET/CT and MRI in the assessment of neoadjuvant chemotherapy treatment response in breast cancer. Correlation with pathological response [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS3-27.

Up-to-date breast cancer imaging

Introduction. Breast cancer is a major health and economic problem in Serbia. On the one hand, most patients see a the doctor at an advanced stage of the disease, and on the other hand, screening response rate is low. Early detection increases the chances of survival. Digital mammography is the gold standard in breast cancer imaging, together with supplemental ultrasound and tomosynthesis. Mammography combined with tomosynthesis has a greater detection rate regardless of breast density, although the difference is more pronounced in high-density lesions, and it has fewer falsenegative results than mammography alone. Ultrasound, apart from being a complementary method, is ideal for ultrasound guided breast biopsy. Magnetic resonance mammography is an imaging method with the highest sensitivity in the detection of invasive breast cancer and has an important role in the evaluation of the post-therapeutic response and in preoperative preparation. Magnetic resonance spectroscopy measures the choline levels and helps to differentiate malignant from benign lesions. It is also a promising method for early assessment of the post-therapeutic response. Positron emission tomography is likely to gain more significant roles in breast cancer imaging in the near future, especially in measuring the treatment response.

Multistakeholder Needs Assessment to Inform the Development of an mHealth-Based Ultrasound-Guided Breast Biopsy Training Program in Nigeria.

PURPOSEThe incidence of breast cancer is rising in Nigeria, and one major barrier to care is the lack of affordable and appropriate breast cancer diagnosis by ultrasound (US)–guided biopsy. The prohibitive cost of US devices limits their availability in low- and middle-income countries. The emergence of mobile health (mHealth) imaging devices may offer an acceptable low-cost alternative. The purpose of this research was to perform a comprehensive needs assessment to understand knowledge, use, training needs, and attitudes as regards image-guided biopsy in Nigeria to inform the development of an mHealth-based US-guided biopsy training program.METHODSA multistakeholder needs assessment was conducted at the Sixth Annual African Research Group for Oncology Symposium. Voluntary anonymous surveys were administered to all attendees. A subset of attendees (ie, surgeons, radiologists, pathologists, and nurses) participated in six focus groups. Survey items and interview guides were developed collaboratively with local and international input.RESULTSSurveys focusing on use, training needs, and attitudes regarding US-guided biopsies were completed with a 55% response rate (n = 54 of 98) among participants from 22 hospitals across Nigeria. Respondents expressed dissatisfaction with the way breast biopsies were currently performed at their hospitals and high interest in having their institution participate in a US-guided biopsy training program. Focus group participants (n = 37) identified challenges to performing US-guided procedures, including equipment functionality and cost, staff training, and access to consumables. Groups brainstormed the design of an mHealth US-guided biopsy training program, preferring a train-the-trainer format combining in-person teaching with independent modules.CONCLUSIONA multidisciplinary needs assessment of local stakeholders identified a need for and acceptability of an mHealth-based US-guided biopsy training program in Nigeria.

Ultrasound calibration with ladder phantom at multiple depths for breast biopsy navigation system

Ultrasound guided breast biopsy navigation system with a graphical user interface and a passive robotic needle holder is developed to increase the performance and reliability of the radiologist. Ultrasound calibration and tool tip calibration are required before using the system. A ladder phantom is developed to be used for ultrasound calibration in real time system with only one ultrasound image required. The passive robotic needle holder structure results in an identity matrix for the makes the rotation matrix; therefore, only translation and scaling are required in the system. This method can be applied to multiple ultrasound depths, which has a relationship at each depth and a relationship to the ultrasound image on the display. The results show high accuracy (<1 mm.) and rapid calibration (5–10 minutes) which is suitable for a real time system like a breast biopsy navigation system based on tests with a breast phantom.

Minimizing Delays in the Breast Cancer Pathway by Integrating Breast Specialty Care Services at the Primary Health Care Level in Zambia.

PURPOSEIn Zambia, more than two-thirds of female patients with breast cancer present with late-stage disease, leading to high mortality rates. Most of the underlying causes are associated with delays in symptom recognition and diagnosis. By implementing breast care specialty services at the primary health care level, we hypothesized that some of the delays could be minimized.METHODSIn March 2018, we established a breast care specialty clinic for women with symptomatic disease within 1 of the 5 district hospitals in Lusaka. The clinic offers breast self-awareness education, clinical breast examination, breast ultrasound, ultrasound-guided breast biopsy, surgery, referral for chemoradiation, follow-up care, and electronic medical records.RESULTSBetween March 2018 and April 2019, of 1,790 symptomatic women who presented to the clinic, 176 (10%) had clinical and/or ultrasound indications for histologic evaluation. Biopsy specimens were obtained using ultrasound-guided core-needle procedures, all of which were performed on the same day as the initial visit. Of the 176 women who underwent biopsy, 112 (64%) had pathologic findings compatible with a primary breast cancer, and of these, 42 (37%) were early-stage (stage I/II) disease. Surgery for early-stage cancers was performed at the district hospital within 2 weeks of the time of definitive pathologic diagnosis. Patients with advanced disease were referred to the national cancer center for multimodality therapy, within a similar time frame.CONCLUSIONBreast care specialty services for symptomatic women were established in a district-level hospital in a resource-constrained setting in Africa. As a result, the following time intervals were minimized: initial presentation and performance of clinical diagnostics; receipt of a definitive pathologic diagnosis and initiation of surgery; receipt of a definitive pathologic diagnosis and referral.

Correlation between ultrasound-guided percutaneous breast biopsy and diffusion-weighted magnetic resonance imaging of the breast for evaluation of solid breast lesions

BackgroundMRI’s role had been increasing in breast imaging. In this study, we evaluated the role of diffusion-weighted MRI in correlation with ultrasound-guided percutaneous breast biopsy for diagnosis of solid breast lesions.ResultsSixty female patients were diagnosed by clinical examination and mammography and planned for ultrasound-guided breast biopsy. Diffusion-weighted MRI was done before the biopsy for results correlation. It was found that the diffusion-weighted MRI was valuable in evaluating solid female breast lesions, showing a sensitivity of 96%, specificity of 91.4%, positive predictive value of 100%, negative predictive value of 97%, and accuracy of 93.3% % compared to pathological results.ConclusionDiffusion-weighted MRI has a great role in evaluating solid breast lesions.

Ultrasound-guided Interfascial Plane Blocks for Non-anesthesiologists in Breast Cancer Surgery: Functional Outcomes and Benefits.

Acute post-operative pain following modified radical mastectomy (MRM) in patients with breast cancer is challenging for anesthesiologists. This study aimed to prospectively compare the quality outcome of interfascial plane blocks performed with ultrasound guidance, and evaluate the consequences of sharing tasks with the breast surgeon. The study involved 255 patients scheduled for unilateral MRM, who were divided into two groups: Pecs group: General anesthesia plus ultrasound-guided modified pectoral nerves blocks type I and II, including serratus and parasternal infiltration according to surgical requirements; and Control group: general anesthesia only. Quality was evaluated based on perioperative opioid consumption, reported pain intensity, rescue analgesic requirement, side-effects and length of hospital stay. Moreover, a breast surgeon with expertise in ultrasound-guided breast biopsy was trained to perform the blocks. The patient benefits from regional anesthesia delivered by a non-anesthesiologist were assessed. Significant reductions were noted in all of the following: Intraoperative opioid consumption (p<0.001), Numerating Rating Scale pain scores taken 0 and 24 h after surgery (p<0.001), post-operative analgesic administration (p<0.001), nausea and vomiting at 0, 6, and 12-h intervals (p<0.05), and hospital stay (p<0.001) were observed in the Pecs group compared with the control group. Furthermore, data obtained from patients receiving the block from the surgeon showed comparable benefits with no complications. Interfascial plane blocks may be an important alternative protocol in MRM, enhancing patient safety and cost benefits. Improvements in cross-disciplinary expertise through flexibility in the training of professionals with other backgrounds may provide effective analgesia and favorable outcomes.

Utilizing Time-Driven Activity-Based Costing to Increase Efficiency in Ultrasound-Guided Breast Biopsy Practice

PurposeIn this study, we used time-driven activity-based costing to increase efficiency in our ultrasound-guided breast biopsy practice by understanding costs associated with this procedure. MethodsWe assembled a multidisciplinary team of all relevant stakeholders involved in ultrasound-guided breast biopsies, including a radiologist, a lead technologist, a clinical assistant, a licensed practical nurse, and a procedural support assistant. The team mapped each step in an ultrasound-guided breast biopsy from the time of scheduling a biopsy to patient checkout. We completed on average 20 time observations of each step involved in these biopsies from a provider’s perspective. Using capacity cost rate, we calculated the cost of all resources including personnel, supply, room, and equipment costs. Several costly steps were identified in the process, which led to the intervention of changing our overlapping biopsy times to staggered biopsy times. Time observations for each step and cost calculations were repeated postintervention. ResultsOur postintervention data showed that the total time spent by the radiologist in an ultrasound breast biopsy decreased by 28%, accounting for 56% of the total cost in comparison with 63% pre-intervention. The radiologist’s wait time decreased by 38%, accounting for 28% of the total cost in comparison with 35% pre-intervention. Our total cost of the procedure decreased by 20%, and the personnel cost decreased by 25%. ConclusionsTime-driven activity-based costing is a practical way to calculate costs and identify non-value-added steps, which can foster strategies to improve efficiency and minimize waste.

Analysis of breast nodule vascularity as a predictive factor for malignancy

Introduction: Ultrasound is considered the main complementary diagnostic method to mammography in screening malignant breast nodules. The fifth edition of the BI-RADS® classification suggests analyzing nodule vascularity and the resistance index (RI) during the ultrasound. However, they are still not considered a decisive factor for the final classification. Objectives: To evaluate if the vascularity of breast nodules is a predictive factor for malignancy, and identify the RI value of the vessel most associated with malignant results. Methodology: This retrospective cross-sectional study assessed 750 ultrasound-guided breast biopsies performed at the Mastology Outpatient Clinic of the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP) from August 2015 to May 2017. The variables analyzed included examination date, ultrasound BI-RADS® category, internal nodule vascularity, RI value, and biopsy result. Exams from patients with no breast nodule were excluded. The statistical analysis was performed using Pearson's X² test. Results: The presence of vessels inside the nodule was highly associated with malignancy (OR=7.2, p&lt;0.0001) and also with BI-RADS® categories of greater risk (p&lt;0.0001). The median RI was 0.7 (interquartile range – IQR=0.23) in benign nodules with vessel and 0.86 (IQR=0.23) in malignant ones, with statistical significance (p&lt;0.0001). The RI cut-off point to predict malignancy was 0.71 with 83.8% accuracy, 91.9% sensitivity, and 57% specificity (according to the Receiver Operating Characteristic – ROC – curve). Nodules initially classified as 4A but with internal vascularity and high resistance (RI&gt;0.71) proved to be malignant in the biopsy in 35.7% of cases, that is, much higher than expected for the category (2% to 10%). Similarly, 72% of nodules initially classified as 4B but with internal vascularity and high resistance were malignant. On the other hand, 18.4% of nodules classified as 4C but without internal vascularity had malignancy confirmed by biopsy, far below the expected for the category (50% to 95%). Conclusion: The presence of internal vascularity and the RI were important factors for differentiating benign nodules from malignant ones on ultrasound, and in images classified as BI-RADS® 4, this information can be essential when dividing these nodules into subcategories (4A, 4B, and 4C).

Ultrasound-Guided Breast Biopsy: Improved Accuracy of 10-G Cable-Free Elite Compared With 14-G CCNB

BackgroundImaging-guided breast biopsy is crucial for breast lesion evaluation. We aim to make the first comprehensive comparison of two different ultrasound-guided breast biopsy devices: 14-G conventional core needle biopsy (CCNB) and the newly applied cable-free, low-vacuum-assisted 10-G breast biopsy system, Elite. MethodsWe retrospectively collected patients with suspected breast cancer who underwent ultrasound-guided 14-G CCNB or 10-G Elite from October 2013 through March 2018 and compared the biopsy result with the result after operation. We analyzed the test performance of the two methods and their accuracy in immunohistochemistry assays mainly including estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2, and Ki67. We also analyzed the accuracy of 10-G Elite with frozen sections. ResultsSix hundred seventy-four patients who underwent 14-G CCNB and 592 patients who underwent 10-G Elite were finally included in the research. Negative predictive value with Elite was higher than with CCNB (Elite 86.5%, CCNB 41.7%, P < 0.001). Sensitivity (Elite 97.7%, CCNB 96.2%, P = 0.1), specificity (Elite 98.7%, CCNB 90.0%, P = 0.1), positive predictive value (Elite 99.8%, CCNB 99.7%, P = 0.7), and false negative rate (Elite 2.3%, CCNB 3.8%, P = 0.1) showed no difference between two devices. In terms of immunohistochemistry assay, Ki67 agreement of Elite was higher than that of CCNB (Elite 79.5%, CCNB 73.4%, P = 0.045). Estrogen receptor agreement (Elite 90.6%, CCNB 87.7%, P = 0.2), progesterone receptor agreement (Elite 83.9%, CCNB 80.9%, P = 0.3), and human epidermal growth factor receptor two agreement (Elite 94.2%, CCNB 93.5%, P = 0.7) showed no difference between Elite and CCNB. The rate of an inconclusive biopsy result was lower with Elite than with CCNB (Elite 1.5%, CCNB 3.3%, P = 0.045). Conclusions10-G Elite has higher negative predictive value, higher Ki67 agreement, and lower inconclusive results than 14-G CCNB. Elite can be a reliable substitute for 14-G CCNB.

Tunability of Acoustic and Mechanical Behaviors in Breast Tissue Mimicking Materials.

In radiology practices, the ultrasound-guided breast biopsy is among the most commonly performed minimally invasive procedures. However, many radiology residents in their graduate residencies are found with little or no hands-on experience with ultrasound-guided breast procedures. To enhance safety, the problem can be solved by the use of anthropomorphic training phantoms which can provide the resident with realistic ultrasound imaging and needle insertion haptic feedback. Stiffness and acoustic properties of breast tissues vary between different people. The training breast phantom should be able to possess different acoustic and mechanical properties which conform the inconsistencies found in real tissues among people. Therefore, this paper investigates the tunability of acoustic and mechanical behaviors in breast tissue mimicking materials (TMMs). Experiments of central composite design (CCD) with a center point, four corner points, and an additional four axis points were used to fit the non-linear regression model of the speed of sound. The same design of experiment approach was then used to fit the second-order response surface of the attenuation coefficient. Suitable series of tissue mimicking materials for the glandular tissue and malignant lesion were suggested. Latin hypercube design method was conducted to evaluate the main factors that affected the mechanical property (Young's modulus) of tissue mimicking materials. The results showed that the recipe of tissue mimicking materials could be customized to possess different acoustic and mechanical properties which conform the inconsistencies found in real breast tissues.

Correction to: Position-based modeling of lesion displacement in ultrasound-guided breast biopsy

The original version of this article unfortunately contained a mistake.

Position-based modeling of lesion displacement in ultrasound-guided breast biopsy.

Although ultrasound (US) images represent the most popular modality for guiding breast biopsy, malignant regions are often missed by sonography, thus preventing accurate lesion localization which is essential for a successful procedure. Biomechanical models can support the localization of suspicious areas identified on a preoperative image during US scanning since they are able to account for anatomical deformations resulting from US probe pressure. We propose a deformation model which relies on position-based dynamics (PBD) approach to predict the displacement of internal targets induced by probe interaction during US acquisition. The PBD implementation available in NVIDIA FleX is exploited to create an anatomical model capable of deforming online. Simulation parameters are initialized on a calibration phantom under different levels of probe-induced deformations; then, they are fine-tuned by minimizing the localization error of a US-visible landmark of a realistic breast phantom. The updated model is used to estimate the displacement of other internal lesions due to probe-tissue interaction. The localization error obtained when applying the PBD model remains below 11mm for all the tumors even for input displacements in the order of 30mm. This proposed method obtains results aligned with FE models with faster computational performance, suitable for real-time applications. In addition, it outperforms rigid model used to track lesion position in US-guided breast biopsies, at least halving the localization error for all the displacement ranges considered. Position-based dynamics approach has proved to be successful in modeling breast tissue deformations during US acquisition. Its stability, accuracy and real-time performance make such model suitable for tracking lesions displacement during US-guided breast biopsy.

Amyloid tumor of the breast

BackgroundAmyloid tumor of the breast is a rare disease, which was first reported in 1973. To date, only six cases have been reported in Japan.Case presentationA 45-year-old woman who had a medical history of Sjogren’s syndrome presented with a lump of 3 cm in diameter on the outer side of the right breast. Mammography showed no abnormality. Ultrasonography showed a well-defined and rough hypoechoic mass of 32 mm in diameter at the site of the lump. With suspicion of breast cancer, an ultrasound-guided vacuum-assisted breast biopsy was performed. For pathological diagnosis, hematoxylin and eosin staining showed deposits of nonstructural substances in the interstitium. The specimen stained red with Congo red staining and showed green birefringence under a polarizing microscope. Thus, the mass was diagnosed as an amyloid tumor. Since the patient had Sjogren’s syndrome, it was considered a breast finding of autoimmune disease. We considered further therapy to be unnecessary, and annual follow-up was recommended.ConclusionsWe diagnosed the mass as an amyloid tumor by an ultrasound-guided vacuum-assisted breast biopsy without resection. The patient had no systemic symptoms suspected systemic amyloidosis, and we diagnosed localized amyloidosis. An amyloid tumor of the breast may show findings suggestive of breast cancer. Pathological diagnosis before surgery is important to avoid excessive invasion. If deposits of nonstructural substances are observed by hematoxylin and eosin staining, Congo red staining should be added.

Teaching surgical skills in a resource-limited setting: Comparing massed versus distributed practice in an ultrasound-guided breast biopsy simulator

Background: Teaching surgical skills in the simulation lab has increased markedly compared to teaching only in the operating room. Although many studies have been performed investigating the optimal teaching methodology for skills acquisition, there is no consensus on the best method. Massed and distributed practices are important methods in teaching procedural skills. Considering the limited human and logistical resources in low and middle-income settings, it is valuable to understand the optimal methodology for learning and acquiring surgical skills. Methods: Thirty-two core needle biopsy-naïve first-year residents and final year medical students rotating in general surgery were enrolled in and completed the study at University Teaching Hospital of Kigali, a tertiary, teaching and referral hospital in Kigali, Rwanda. They were assigned to a “massed” group (i.e., one time, 3-hour practice) or “distributed” group (i.e., 1-hour practice per week for 3 weeks). Trainees were taught ultrasound-guided core needle biopsy on a high-fidelity breast simulator. All participants completed pre- and post-tests and an evaluation of skill retention was performed one month after completion of the training. Analysis of performance was completed, and p-value ≤ 0.05 was considered statistically significant. Results: There was no difference between performance on the pretest (p=0.985) and the posttest (p=0.680). Both groups demonstrated improvement after implementation of the simulation training when comparing pretest and posttest results (p&lt;0.001); there were no differences in the evaluation of skills retention after one month after the training between the two groups (p=0.273). Conclusions: The results of this study demonstrate that both groups have improved significantly their knowledge and skills. Trainees have similar retention of skills in ultrasound guided core needle biopsy on a breast simulator whether trained under a massed or distributed practice schedule. Both methods may be considered in our setting for teaching surgical skills. Keywords: surgical simulation; resource-limited setting; global surgery

Towards the use of diffuse reflectance spectroscopy for real-time in vivo detection of breast cancer during surgery

BackgroundBreast cancer surgeons struggle with differentiating healthy tissue from cancer at the resection margin during surgery. We report on the feasibility of using diffuse reflectance spectroscopy (DRS) for real-time in vivo tissue characterization.MethodsEvaluating feasibility of the technology requires a setting in which measurements, imaging and pathology have the best possible correlation. For this purpose an optical biopsy needle was used that had integrated optical fibers at the tip of the needle. This approach enabled the best possible correlation between optical measurement volume and tissue histology. With this optical biopsy needle we acquired real-time DRS data of normal tissue and tumor tissue in 27 patients that underwent an ultrasound guided breast biopsy procedure. Five additional patients were measured in continuous mode in which we obtained DRS measurements along the entire biopsy needle trajectory. We developed and compared three different support vector machine based classification models to classify the DRS measurements.ResultsWith DRS malignant tissue could be discriminated from healthy tissue. The classification model that was based on eight selected wavelengths had the highest accuracy and Matthews Correlation Coefficient (MCC) of 0.93 and 0.87, respectively. In three patients that were measured in continuous mode and had malignant tissue in their biopsy specimen, a clear transition was seen in the classified DRS measurements going from healthy tissue to tumor tissue. This transition was not seen in the other two continuously measured patients that had benign tissue in their biopsy specimen.ConclusionsIt was concluded that DRS is feasible for integration in a surgical tool that could assist the breast surgeon in detecting positive resection margins during breast surgery.Trail registration NIH US National Library of Medicine–clinicaltrails.gov, NCT01730365. Registered: 10/04/2012 https://clinicaltrials.gov/ct2/show/study/NCT01730365

Magnetic resonance imaging of fibroadenoma-like lesions and correlation with Breast Imaging-Reporting and Data System and Kaiser scoring system.

BackgroundMultiple breast lesions resembling fibroadenomas are a common imaging finding in patients presenting to the mammography unit at Dr George Mukhari Academic Hospital in the North-West district of Tshwane, South Africa. Patients often present with multiple lesions, up to 20 lesions per breast. These lesions often have atypical features on ultrasound and/or a clinical history of growth is commonly given. Phyllodes tumours may be indistinguishable from fibroadenomas and breast cancers may on occasion present with benign features, which can lead to misdiagnosis. Breast magnetic resonance imaging (bMRI) evaluation of lesions resembling fibroadenomas may improve accurate assessment and identification of lesions requiring biopsy.ObjectivesTo assess the reliability of bMRI to characterise lesions resembling fibroadenomas on ultrasound, using the Breast Imaging-Reporting and Data System (BI-RADS) and Kaiser scoring systems with histopathological correlation.MethodA quantitative, prospective, investigative study was performed with a sample size of 100 breast lesions among a total of 35 patients at Dr George Mukhari Academic Hospital. Patients were recruited after a breast ultrasound investigation revealed lesions resembling fibroadenomas, but with an indication for ultrasound-guided biopsy, for example, very large size, atypical features on ultrasound or a history of recent growth. The bMRI was performed prior to the ultrasound-guided breast biopsies. Three investigators independently evaluated the bMRI and applied BI-RADS descriptors to each lesion. The Kaiser score was then calculated for each lesion. Statistics were calculated using Pearson’s and Spearman’s coefficients for inter-reader variability, kappa scores for BI-RADS and Kaiser score correlation with histology.ResultsEvaluation with bMRI, BI-RADS and the Kaiser scoring system showed statistically significant correlation with each other and with histopathology results for each lesion. There was statistically significant agreement among the investigators regarding the interpretation of the lesions and allocation of appropriate BI-RADS scores.ConclusionMultiple lesions resembling fibroadenomas can be evaluated with bMRI when multiple breast biopsies would not be feasible. With a good imaging protocol and technique, adequate interpretation skills by the radiologist and the use of the Kaiser scoring system, an accurate diagnosis can be achieved.

CMOS High-Voltage Analog 1–64 Multiplexer/Demultiplexer for Integrated Ultrasound Guided Breast Needle Biopsy

Ultrasound guided needle biopsy is an important method for collection of breast cancer tissue. In this paper, we report on the design and testing of a high-voltage 1 to 64 Multiplexer/Demultiplexer (MUX/De-MUX) integrated circuit (IC) for ultrasound-guided breast biopsy applications implemented in a high-voltage CMOS process. The IC is intended to be incorporated inside the breast biopsy needle and is designed to fit inside the needle inner diameter of 2.38 mm. The MUX/De-MUX electronics are made up of three parts, including a low-voltage 6 to 64 decoder, a level shifter to convert from low voltage to high voltage, and analog high-voltage switches. Experimental results show a -3-dB bandwidth of over 70 MHz, Rds (on) of , -2.279-dB insertion loss, and -17.5-dB off isolation at 70 MHz with low-voltage input. Finally, we present results obtained via synthetic aperture imaging using the fabricated MUX/De-Mux device and a high-frequency ultrasound array. This device and technique hold promise for high-frequency imaging probes where a limited number of elements are used and the depth of penetration is short such as in breast biopsy and intravascular applications.