Supervisors info:
Αικατερίνη Μαλαγάρη, Αν. Καθηγήτρια, Ιατρική,ΕΚΠΑ
Ευθυμία Αλεξοπούλου, Αν. Καθηγήτρια, Ιατρική,ΕΚΠΑ
Δημήτρης Φιλιππιάδης, Επ. Καθηγητής, Ιατρική,ΕΚΠΑ
Summary:
Preface
The technologic advances in breast ultrasound systems over the past several decades have allowed this technology to be utilized for the real-time evaluation, diagnosis, and treatment of patients being seen for breast abnormalities.
Breast sonography has been available for approximately 60 years.
Lumps or abnormalities in the breast are often detected by physical examination, mammography, or other imaging studies. However, it is not always possible to tell from these imaging tests whether a growth is benign or cancerous.
A breast biopsy is performed to remove some cells from a suspicious area in the breast and examine them under a microscope to determine a diagnosis. This can be performed surgically or, more commonly, by a radiologist using a less invasive procedure that involves a hollow needle and image-guidance. Image-guided needle biopsy is not designed to remove the entire lesion but to obtain a small sample of the abnormality for further analysis.
Image-guided biopsy is performed by taking samples of an abnormality under some form of guidance such as ultrasound, MRI or mammography.
In ultrasound-guided breast biopsy, ultrasound imaging is used to help guide the radiologist's instruments to the site of the abnormal growth.
Anyone participating in a breast imaging practice appreciates that the patient interaction required for women undergoing imaging involves care, sensitivity, and patience in the communication of results to patients.
Additionally, a general knowledge about cancer risks, limitations of imaging, and treatment of breast cancer is often required in discussions with women and their families.
This is particularly important in the discussion of biopsy options to patients and the communication of biopsy results. The willingness and ability of the radiologist to have these discussions in a compassionate manner is as important to the patient and her family as the skillful performance of these procedures. It is impossible to overemphasize the importance of a warm, supportive, honest interaction with the patient as part of these procedures.
They are best performed on patients who trust and are comforted by the physician doing these interventions. The physician must also be honest with the patient about their limitations and their failure to obtain a definitive result, thereby requiring repeat biopsy, when this occurs.
Physicians performing these procedures need to understand that they are often considerably more time consuming than just performing the procedure itself. When radiologists incorporate these procedures into their practice, there is a need to provide for the time and support required to communicate results and to maintain quality control. The success of these procedures is only assured when results of the pathologic analysis are correlated with the imaging studies. Personal communication with the pathologist or surgeon is sometimes required to optimize quality of care.
Radiologists need to appreciate that these procedures should not be considered completed until the pathology report addresses the lesion that has been biopsied, the specimen radiograph shows adequacy of excision of the area of concern, the results have been communicated to the patient and/or her clinician, and this has been documented in the report of the procedure.
Performance of these procedures also requires extra time, effort, and experience for the technologist who assists with them. Participation in these procedures involves dedication and skills that are beyond those needed for the performance of general radiography, sectional imaging, or noninterventional breast imaging. Training in infection control is also needed. The maintenance and quality control of new equipment must also be learned. Radiologists need to recognize these special skills.
When any intervention is performed, there is a possibility of complications. This is true with the procedures described in this text. Before performing any of these procedures, the physician should have in place a method for treating them. Whether they are treated by the radiologist or the patient is referred to a surgeon for treatment, the way in which treatment is delivered should be arranged before the physician is confronted, for example, with a large hematoma, pneumothorax or infection.
It is hoped that this text will encourage new physicians to perform these procedures and assist those who have incorporated them into their practices. Thousands of women require each of the interventions described in this text each year. The proliferation of skills needed to perform them will only result in the advantage inherent in each of these procedures being made available to larger numbers of women. It will make it possible to diagnose breast diseases more quickly, less expensively, and with less cosmetic
deformity. The performance of these techniques will also enhance the sense of satisfaction derived from a breast imaging practice.
This text has only been possible because of the previous work of numerous, distinguished authors . The demand on the time of each is profound, and I am extremely grateful and honored that they have been willing to participate in the production of this work.
June 2017 , Athens , Greece
Keywords:
Biopsies, Breast, Ultrasound, Cancer, Breast cyst, Interventional radiology
