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Author: Agency for and Quality
Publisher:
ISBN: 9781503221901
Category :
Languages : en
Pages : 250
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Book Description
Approximately one in eight U.S. women will develop breast cancer during her lifetime. Because the earliest stages of breast cancer are asymptomatic, the process of breast cancer diagnosis is often initiated by detecting an abnormality through self-examination, physical examination by a clinician, or screening mammography. If the initial assessment suggests that the abnormality could be breast cancer, the woman is likely to be referred for a biopsy-a sampling of cells or tissue from the suspicious lesion. Three techniques for obtaining samples from suspicious breast lesions are available: fine-needle aspiration, biopsy with a hollow core needle, or open surgical retrieval of tissue. Fine-needle aspiration samples cells and does not assess tissue architecture, is generally considered less sensitive than core needle and open biopsy methods, and is used less frequently. Core-needle biopsy, which retrieves a sample of tissue, and open surgical procedures are the most frequently used biopsy methods. Lesion samples obtained by core needle or surgical biopsy are evaluated by pathologists and classified into histological categories with the primary goal of determining whether the lesion is benign or malignant. Because core needle biopsy samples only part of the breast abnormality, a risk exists that a lesion will be classified as benign, high risk, or noninvasive when invasive cancer is in fact present in unsampled areas. Open surgical biopsy samples most or all of the lesion, and is therefore considered to have a smaller risk of misdiagnosis. However, open procedures may carry a higher risk of complications, such as bleeding or infection, compared to core needle biopsy procedures.5 Therefore, if core needle biopsy is also highly accurate, women and their clinicians may prefer some type of core needle biopsy to open surgical biopsy. In 2009, the ECRI Evidence-based Practice Center conducted a comparative effectiveness review for core needle versus open surgical biopsy commissioned by the Agency for Health Care Research and Quality. That evidence report assessed the diagnostic test performance and adverse events of core needle biopsy techniques compared to open surgical biopsy and evaluated differences between open biopsy and core needle biopsy with regards to patient preferences, costs, availability, and other factors. The authors concluded that core needle biopsies were almost as accurate as open surgical biopsies, had a lower risk of severe complications, and were associated with fewer subsequent surgical procedures. The publication of additional studies and changes in practice raised the concern that the conclusions of the original report may be out of date. New studies may also provide additional information allowing the exploration of heterogeneity for test performance and safety outcomes. Therefore, an updated review of the published literature was considered necessary to synthesize all evidence on currently available methods for core needle and open surgical breast lesion biopsy. We specified the following three Key Questions to guide the conduct of the update: Key Question 1: In women with a palpable or nonpalpable breast abnormality, what is the test performance of different types of core needle breast biopsy compared with open biopsy for diagnosis? Key Question 2: In women with a palpable or nonpalpable breast abnormality, what are the adverse events (harms) associated with different types of core needle breast biopsy compared with open biopsy for diagnosis? Key Question 3: How do open biopsy and various core needle techniques differ in terms of patient preference, availability, costs, availability of qualified pathologist interpretations, and other factors that may influence choice of a particular technique?
Author: Agency for and Quality
Publisher:
ISBN: 9781503221901
Category :
Languages : en
Pages : 250
Get Book Here
Book Description
Approximately one in eight U.S. women will develop breast cancer during her lifetime. Because the earliest stages of breast cancer are asymptomatic, the process of breast cancer diagnosis is often initiated by detecting an abnormality through self-examination, physical examination by a clinician, or screening mammography. If the initial assessment suggests that the abnormality could be breast cancer, the woman is likely to be referred for a biopsy-a sampling of cells or tissue from the suspicious lesion. Three techniques for obtaining samples from suspicious breast lesions are available: fine-needle aspiration, biopsy with a hollow core needle, or open surgical retrieval of tissue. Fine-needle aspiration samples cells and does not assess tissue architecture, is generally considered less sensitive than core needle and open biopsy methods, and is used less frequently. Core-needle biopsy, which retrieves a sample of tissue, and open surgical procedures are the most frequently used biopsy methods. Lesion samples obtained by core needle or surgical biopsy are evaluated by pathologists and classified into histological categories with the primary goal of determining whether the lesion is benign or malignant. Because core needle biopsy samples only part of the breast abnormality, a risk exists that a lesion will be classified as benign, high risk, or noninvasive when invasive cancer is in fact present in unsampled areas. Open surgical biopsy samples most or all of the lesion, and is therefore considered to have a smaller risk of misdiagnosis. However, open procedures may carry a higher risk of complications, such as bleeding or infection, compared to core needle biopsy procedures.5 Therefore, if core needle biopsy is also highly accurate, women and their clinicians may prefer some type of core needle biopsy to open surgical biopsy. In 2009, the ECRI Evidence-based Practice Center conducted a comparative effectiveness review for core needle versus open surgical biopsy commissioned by the Agency for Health Care Research and Quality. That evidence report assessed the diagnostic test performance and adverse events of core needle biopsy techniques compared to open surgical biopsy and evaluated differences between open biopsy and core needle biopsy with regards to patient preferences, costs, availability, and other factors. The authors concluded that core needle biopsies were almost as accurate as open surgical biopsies, had a lower risk of severe complications, and were associated with fewer subsequent surgical procedures. The publication of additional studies and changes in practice raised the concern that the conclusions of the original report may be out of date. New studies may also provide additional information allowing the exploration of heterogeneity for test performance and safety outcomes. Therefore, an updated review of the published literature was considered necessary to synthesize all evidence on currently available methods for core needle and open surgical breast lesion biopsy. We specified the following three Key Questions to guide the conduct of the update: Key Question 1: In women with a palpable or nonpalpable breast abnormality, what is the test performance of different types of core needle breast biopsy compared with open biopsy for diagnosis? Key Question 2: In women with a palpable or nonpalpable breast abnormality, what are the adverse events (harms) associated with different types of core needle breast biopsy compared with open biopsy for diagnosis? Key Question 3: How do open biopsy and various core needle techniques differ in terms of patient preference, availability, costs, availability of qualified pathologist interpretations, and other factors that may influence choice of a particular technique?
Author: Issa J. Dahabreh
Publisher:
ISBN:
Category :
Languages : en
Pages :
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Book Description
OBJECTIVE: Core needle biopsy and open surgical biopsy are the most frequently used procedures for diagnosis of suspicious breast lesions. An AHRQ evidence report on the comparative effectiveness and adverse events of breast biopsy methods was completed in 2009. The availability of additional studies and the uncertainties surrounding newer biopsy techniques prompted an update of that report. STUDY ELIGIBILITY CRITERIA: We searched nine electronic databases (last search on December 16, 2013) for English-language full-text reports of prospective or retrospective cohort studies of women not previously diagnosed with breast cancer who were undergoing biopsy for diagnosis of a breast lesion. STUDY APPRAISAL AND SYNTHESIS METHODS: A single investigator extracted quantitative and qualitative data from each study; a second reviewer verified extracted data. We assessed the strength and applicability of the evidence. We performed Bayesian meta-analyses to estimate summary test performance and performed indirect comparisons to assess the relative effectiveness of alternative core needle biopsy methods. Statistical models accounted for between-study heterogeneity. RESULTS: One hundred and sixty studies of moderate to high risk of bias provided information on the test performance of alternative core needle biopsy techniques. We found one new study investigating the test performance of open biopsy. For women at average risk of cancer, both ultrasound- and stereotactically guided biopsies had average sensitivities higher than 0.97 and average specificities ranging from 0.92 to 0.99; freehand biopsy methods had average sensitivity of 0.91 and specificity of 0.98. However, evidence on the test performance of magnetic resonance imaging (MRI)-guided biopsy (6 studies) was insufficient to draw conclusions. Test performance did not differ between women at average and high baseline risk of cancer, but results were imprecise. Test performance of automated and vacuum-assisted devices (when using the same imaging guidance) was fairly similar (absolute differences in sensitivity and specificity d 0.1). One hundred and forty-one studies contributed information on potential harms of different core needle biopsy techniques. Overall, core needle biopsy had a lower risk of complications than open surgical biopsy; however information on the latter was sparse. The absolute incidence of adverse events was low and the incidence of severe complications was less than 1 percent for all techniques. Vacuum-assisted procedures appeared to be associated with increased bleeding and hematoma formation; biopsies performed with patients seated upright appeared to be associated with increased risk of vasovagal reactions. Harms were reported inconsistently, raising concerns about selective outcome reporting. We found 10 case reports of patients developing tumors at the site of prior core needle biopsies. We found information on only a few patient-relevant and resource-related outcomes. Based on 42 studies, core needle biopsy obviated the need for surgical procedures in about 75 percent of women. Meta-analysis of 10 studies reporting the number of surgical procedures required after biopsy suggested that the odds of requiring only one procedure were almost 15 times as high among women receiving core needle biopsy, as compared to those receiving open surgical biopsy. However, this result may be confounded by indication. LIMITATIONS: Patient-level data were unavailable and information about study- or population-level characteristics was too limited to allow the identification of modifiers of test performance, adverse events, or clinical outcomes. Studies reported adverse events incompletely, and did not provide details of their outcome ascertainment methods. CONCLUSIONS: A large body of evidence suggests that ultrasound and stereotactically guided core needle biopsy procedures have sensitivity and specificity close to that of open biopsy procedures, and are associated with fewer adverse events. The strength of the evidence on the test performance of these methods is deemed moderate because studies are at medium to high risk of bias, but provide precise and fairly consistent results. Freehand procedures have lower sensitivity than imaging-guided methods. The strength of evidence on the comparative test performance of automated and vacuum-assisted devices (when using the same imaging guidance) is deemed low, because of concerns about the risk of bias of included studies and the reliance on indirect comparisons. There were insufficient data to draw conclusions for MRI-guided biopsy or women at high baseline risk of cancer. There is low strength of evidence that vacuum-assisted procedures have a higher risk of bleeding than automated methods. There is moderate strength of evidence that women diagnosed with breast cancer by core needle biopsy are more likely to have their cancer treated with a single surgical procedure, compared with women diagnosed by open surgical biopsy.
Author: Leslie D. Schmidt
Publisher: Nova Science Publishers
ISBN: 9781612097992
Category : Breast
Languages : en
Pages : 0
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Book Description
Open surgical biopsy is the "gold standard" or "reference standard" method of evaluating a suspicious breast lesion because it is thought to be very accurate in diagnosing these lesions. While generally considered safe, it is a surgical procedure that, like all surgeries, places the patient at risk of experiencing morbidities and, in rare cases, mortality. However, only 20 to 30 percent of women who undergo breast biopsy procedures are diagnosed with cancer. A less invasive method for evaluation of suspicious breast lesions would be preferable if it were sufficiently accurate. This book examines the effectiveness of core-needle and open-surgical biopsy in breast cancer evaluation.
Author: U. S. Department of Health and Human Services
Publisher: Createspace Independent Pub
ISBN: 9781484974544
Category : Medical
Languages : en
Pages : 300
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Book Description
Breast cancer is the second most common malignancy of women. The American Cancer Society estimates that in the U.S. in 2009, 67,280 women will have been diagnosed with new cases of in situ cancer, 192,370 women will have been newly diagnosed as having invasive breast cancer, and there will be 40,170 deaths due to this disease. In the general population, the cumulative risk of being diagnosed with breast cancer by age 70 is estimated to be 6% (lifetime risk of 13%). Ductal carcinoma, including ductal carcinoma in situ (DCIS), is the most common malignancy of the breast. It arises within the ducts of the breast. DCIS is early breast cancer confined to the inside of the ductal system, and invasive (also called infiltrating) ductal carcinoma is a later stage that has broken through the walls of the ducts and invaded nearby tissues. Lobular carcinoma is similar to ductal carcinoma, first arising in the terminal ducts of the lobules and then invading through the walls of the ducts and into nearby tissues. Atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS) are caused by abnormal cellular proliferation within the terminal ducts of the lobules. The two conditions are distinguished primarily by the degree to which the ducts are filled by cells. Women diagnosed with ALH or LCIS are at elevated risk of developing an invasive carcinoma in the future. Other types of benign breast abnormalities that have been linked to an elevated risk of invasive carcinoma or a finding of associated invasive carcinoma upon excision are atypical ductal hyperplasia (ADH), papillary lesions, and radial scars. Breast cancer is usually first detected by feeling a lump on physical examination or by observing an abnormality during x-ray screening mammography. Survival rates depend on the stage of disease at diagnosis. At stage 0 (carcinoma in situ) the five-year survival rate is close to 100%. The five-year survival rate for women with stage IV (cancer that has spread beyond the breast) is only 27%. These observations suggest that breast cancer mortality rates can be significantly reduced by identifying cancers at earlier stages. Because early breast cancer is asymptomatic, the only way to detect it is through population-wide screening. Mammography is a widely accepted method for breast cancer screening. Mammography uses x-rays to examine the breast for clusters of microcalcifications, circumscribed and dense masses, masses with indistinct margins, architectural distortion compared with the contralateral breast, or other abnormal structures. The American College of Radiology has created a standardized system for reporting the results of mammography, the Breast Imaging Reporting and Data System (BI-RADS(r) ). There are seven categories of assessment and recommendation: 0 Need additional imaging evaluation and/or prior mammograms for comparison 1 Negative 2 Benign finding 3 Probably benign finding. Initial short interval follow-up suggested 4 Suspicious abnormality. Biopsy should be considered. 5 Highly suggestive of malignancy. Appropriate action should be taken. 6 Known biopsy-proven malignancy. Appropriate action should be taken. This systematic review was commissioned by the Agency for Healthcare Research and Quality (AHRQ) to address the following Key Questions; they include, but are not limited to: 1. In women with a palpable or non-palpable breast abnormality, what is the accuracy of different types of core-needle breast biopsy compared with open biopsy for diagnosis? 2. In women with a palpable or non-palpable breast abnormality, what are the harms associated with core-needle breast biopsy compared to the open biopsy technique in the diagnosis of breast cancer? 3. How do open biopsy and various core-needle techniques differ in terms of patient preference, availability, costs, availability of qualified pathologist interpretations, and other factors that may influence choice of particular technique?
Author: Wendy Bruening
Publisher:
ISBN:
Category : Electronic book
Languages : en
Pages :
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Book Description
The large number of possible methods of performing breast biopsy can be bewildering to patients and health care providers alike. Which method should one choose? Is a particular method clearly superior, or does the method of choice depend upon individual patient characteristics? We have performed a systematic review intended to evaluate the accuracy of different methods of performing breast biopsy and to explore what factor(s) may impact the accuracy and possible harms of different methods of performing breast biopsy.
Author:
Publisher:
ISBN:
Category :
Languages : en
Pages :
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Book Description
Author: Ira J. Bleiweiss
Publisher: Elsevier Health Sciences
ISBN: 1416000267
Category : Biopsy
Languages : en
Pages : 203
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Book Description
Introduction and general considerations -- Well-circumscribed solid lesions -- Well-circumscribed solid lesions with heterogeneous radiodensity -- Largely cystic lesions -- Partially solid, partially cystic lesions -- Well-circumscribed solid malignancies -- Irregular densities -- Spiculated architectural distortion -- Architectural distortion -- Introduction to stereotactic core biopsies for calcifications -- Calcium oxalate crystals -- Linear high-density calcifications -- Clustered low-density granular calcifications -- Linear and branching calcifications -- Miscellaenous unusual and rare lesions -- Complications and follow-up: after the core biopsy -- Postscript.
Author: Sandra J. Shin
Publisher: Springer Nature
ISBN: 3031055322
Category : Medical
Languages : en
Pages : 1025
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Book Description
Breast cancer remains the leading cause of cancer in women, which makes accurate diagnoses on core needle biopsy (CNB) specimens of vital importance in staging and guiding therapy decisions for patients. The first edition of this multi-authored text written by leaders in the field from major academic medical centers provided a comprehensive guide on diagnostic breast pathology in the core biopsy setting. In addition to in-depth coverage of benign and malignant entities encountered in breast core biopsies, the book provided additional resources to improve diagnostic accuracy such as pattern-based approaches to evaluation, mimickers of breast lesions arising in extra-mammary sites, and pitfalls specific to small tissue samples. In recent years, there have been several notable developments in the field of breast pathology including revisions in AJCC breast cancer staging, updated guidelines in the testing and reporting of ER, PR, and HER2, as well as implementation of immunotherapy and companion biomarker testing. In addition, several key updates were included in the most recent edition of the WHO Classification of Breast Tumours (2020). In addition to updates specific to individual breast entities, the second edition will detail updates regarding biomarker testing in the primary and metastatic setting, and incorporate newly defined entities and updated definitions of rare tumors in alignment with the WHO Classification of Breast Tumours (2020). Furthermore, this edition will address the role of CNB in companion biomarker testing for eligibility for immunotherapy in the context of advanced triple-negative breast carcinoma. Written by leaders in the field and edited by expert breast pathologists, The Second Edition of Comprehensive Guide to Core Needle Biopsies of the Breast is the definitive reference on breast core needle biopsies for practicing pathologists, pathology trainees, oncologists and clinicians of patients with breast disease.
Author: David D. Dershaw
Publisher: Springer Science & Business Media
ISBN: 0387224394
Category : Medical
Languages : en
Pages : 219
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Book Description
Imaging-Guided Interventional Breast Techniques instructs the reader on the performance of invasive breast procedures and discusses issues related to the selection and purchase of equipment to perform these cutting edge techniques. This "how to" text will include the most up-to-date information on biopsy technology, including the advantages and disadvantages of biopsy probes. The book will also address issues of patient management and discuss the results of the latest stuides on problems in the histopathologic interpretation of tissue obtained during biopsies. Additionally, the book is designed to assist the physician in assessment of equipment in compliance with professional regulations. Enhanced by over 200 high quality images, this text is ideal for specialists who perform interventional breast procdures.
Author: Renzo Brun del Re
Publisher: Springer Science & Business Media
ISBN: 3540316116
Category : Medical
Languages : en
Pages : 230
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Book Description
Modern imaging methods have made it possible to detect breast cancer at an earlier stage than in the past. Nevertheless, a large majority of suspicious findings at screening subsequently prove to be benign. It is therefore important to be able to identify benign lesions in a manner that is reliable, tissue sparing, patient friendly, and cost-effective. More than 70% of breast biopsies can now be performed using minimally invasive procedures that meet these criteria. This book examines in detail vacuum-assisted minimally invasive breast biopsy systems (ATEC, EnCor, Intact, Mammotome and Vacora), stereotactic systems, MRI-guided procedures, and ductoscopy. Further chapters are devoted to the pathology of the breast tissue obtained using these procedures, their limitations, the implications of recent advances in breast imaging, and the results of cost-benefit analyses. The closing chapter provides a systematic review and meta-analysis of recent data.
