Barbara Schepps

Characterization of Breast Masses With Sonography Can Biopsy of Some Solid Masses Be Deferred

To determine whether sonography can be used to categorize some solid breast masses as probably benign so that biopsy can be deferred.

Stereotactic Breast Biopsy: Comparison of Histologic Underestimation Rates with 11- and 9-Gauge Vacuum- Assisted Breast Biopsy

OBJECTIVE The purpose of this study was to compare histologic underestimations at stereotactic 11- and 9-gauge vacuum-assisted breast biopsy. MATERIALS AND METHODS The reports of 1,223 consecutive stereotactic vacuum-assisted breast biopsies were retrospectively reviewed. An 11-gauge device was used to perform 828 and a 9-gauge device to perform 395 biopsies. The pathologic results were reviewed for all cases. Biopsy results of atypical ductal hyperplasia and ductal carcinoma in situ were compared with the pathologic results after surgical excision. Underestimation was defined as the need to upgrade atypical ductal hyperplasia to ductal carcinoma in situ or invasive carcinoma at surgery and to upgrade ductal carcinoma in situ to invasive carcinoma. Statistical significance was determined with the chi-square test and 95% CI. RESULTS In the 11-gauge group, 12 (26%) of 46 cases of atypical ductal hyperplasia were upgraded to ductal carcinoma in situ and one (2%) of the cases to invasive carcinoma. In the 9-gauge group, six (22%) of 27 cases of atypical ductal hyperplasia were upgraded to ductal carcinoma in situ and two (7%) of the cases to invasive carcinoma. In the 11-gauge group, 35 (28.7%) of 122 cases of ductal carcinoma in situ were upgraded to invasive carcinoma. In the 9-gauge group, 10 (23%) of 44 cases of ductal carcinoma in situ were upgraded to invasive carcinoma. CONCLUSION There was no statistically significant difference between 11-gauge biopsy and 9-gauge biopsy in underestimation of atypical ductal hyperplasia and ductal carcinoma in situ.

Preferential Use of Sonographically Guided Biopsy to Minimize Patient Discomfort and Procedure Time in a Percutaneous Image-Guided Breast Biopsy Program

Objective. To determine whether preferential use of sonographic guidance for percutaneous biopsy of breast masses results in a subset of patients with a shorter procedure time and less discomfort compared with patients undergoing stereotactic biopsy. Methods. A prospective observational study was performed on 193 women undergoing percutaneous image‐guided breast biopsy between 1997 and 1999. Data were collected on room time, physician time, and patient comfort levels for 122 stereotactic and 71 sonographically guided biopsies. Differences between stereotactic and sonographically guided biopsy for all lesions and for masses were analyzed for statistical significance. Results. Mean room times were 62.2 minutes for stereotactic biopsy and 39.4 minutes for sonographically guided biopsy (P < .0001). Mean physician times were 23.0 minutes for stereotactic biopsy and 15.8 minutes for sonographically guided biopsy (P < .0001). When we limited our analyses to women undergoing biopsy for masses, the difference in physician time largely disappeared, but the difference in room time remained (P < .0001). Women undergoing stereotactic biopsy were more likely to report discomfort due to body positioning than were women undergoing sonographically guided biopsy (P < .001). These differences existed whether we included all lesions or restricted our analyses to masses. Conclusions. Preferential use of sonographically guided breast biopsy for masses results in shorter procedure times and less patient discomfort compared with prone stereotactic biopsy.

Mammography-related anxiety: effect of preprocedural patient education.

OBJECTIVES To determine the effect of preprocedural education on mammography-related anxiety. MATERIALS AND METHODS A total of 613 women undergoing mammography were surveyed regarding anxiety about the procedure and expected results. Half the study population watched an educational videotape and half watched an entertaining movie in the waiting room. RESULTS Anxiety levels about results were significantly higher than anxiety levels about the procedure (P <.001). There was no difference in procedural or cancer anxiety levels among women shown the educational tape and those shown the entertaining movie. CONCLUSION The fear of discovering breast cancer generates most of mammography-related anxiety. Preprocedural education did not affect procedural or cancer-related anxiety.

Radiation oncologists in 2000: demographic, professional, and practice characteristics

PURPOSE To describe the demographic, professional, and practice characteristics of radiation oncologists, emphasizing comparisons to data from a similar 1995 Survey. METHODS AND MATERIALS In spring 2000, we surveyed 603 randomly selected radiation oncologists by mail, using a one-page questionnaire-455 responded. We weighted responses to make answers representative of all radiation oncologists in the United States. RESULTS Approximately 45% of post-training, professionally active, radiation oncologists were <45 years old and 22% were women. Forty-two percent of radiation oncologists in training were women. Thirty-three percent of radiation-oncology-only practices were solo practices. The greatest percentage of post-training, professionally active, radiation oncologists were in nonacademic private radiation oncology practices. Fifty-three percent of post-training, professionally active, radiation oncologists reported that their workload was about right. Eighteen percent of individuals 60-64 years old and approximately two-thirds of those > or =65 years old were not working (retired). The full-time equivalency of those aged 55-74 fell by 12 percentage points between 1995 and 2000. CONCLUSIONS Most demographic, professional, and practice characteristics remained relatively constant between 1995 and 2000, with the exception of work status patterns. Radiation oncologists reported a more balanced workload than that reported by diagnostic radiologists. The surplus of radiation oncologists, which was predicted in the mid-1990s, was not demonstrated.

Ultrasound-guided Large-Core Needle Biopsy of the Breast: Frequency and Results of Repeat Biopsy

Objective.To determine the frequency of repeat biopsy after ultrasound (US)-guided large-core needle biopsy (LCNB) of the breast and to determine malignancy rate in these cases.Methods.The authors retrospectively reviewed 460 US-guided LCNB procedures in 413 women performed from 1995 to 1997. The nu