Training module to teach ultrasound-guided breast biopsy skills to residents improves accuracy.

OBJECTIVE: To evaluate the effectiveness of a training module in teaching residents the skills necessary to perform accurate and safe ultrasound-guided breast biopsies (USGBB). METHODS: Twelve residents with no USGBB experience, but variable ultrasound (US) experience, were randomly assigned to 2 groups; 1 group participated in a training module, and the other received no training. Each resident then attempted 30 core biopsies of "lesions" implanted in breast phantoms. Successful biopsies extracted some "lesion" material. "Chest wall" hits were also counted. RESULTS: The trained residents had significantly fewer "chest wall" hits than the untrained group (p < 0.002), but there was no significant difference in the number of successful biopsies (73% v. 43%, p = 0.09). The subgroup of residents who were USGBB trained but inexperienced in US (n = 4) achieved more successful biopsies (p < 0.05) and fewer "chest wall" hits (p < 0.01) than their matched untrained cohort (n = 3). The trained US-experienced subgroup (n = 2) had fewer "chest wall" hits than the matched untrained subgroup (n = 3; p < 0.05) but similar biopsy success rates. Untrained US-experienced residents (n = 3) had more successful biopsies than untrained US-inexperienced residents (n = 3; p < 0.001) and similar "chest wall" hits. CONCLUSION: Residents with training perform USGBBs more safely, and training significantly improves accuracy of USGBB in residents with no US experience. US experience improves biopsy success rates but does not affect safety levels of residents with no USGBB training.

Comparison of core needle breast biopsy techniques: freehand versus three-dimensional US guidance.

RATIONALE AND OBJECTIVES: No single method is generally accepted for evaluating the accuracy of breast biopsy techniques before their clinical implementation. The purpose of this study was to test a new process for evaluating biopsy techniques by using it in the evaluation of a prototype three-dimensional ultrasound (US)-guided biopsy device. MATERIALS AND METHODS: The biopsy accuracy of a new three-dimensional US-guided breast biopsy device was compared to that of the accepted clinical practice of biopsy by expert radiologists with two-dimensional freehand US guidance. Biopsies were performed in chicken tissue phantoms containing 3.2-mm lesions made of poly(vinyl alcohol) cryogel. The criterion for a successful biopsy was the presence of lesion in the sample. The equivalence limit difference tested was 10% by using a power of 90% and a two-sided test significance level, a, of 10%. RESULTS: The biopsy success rate of the three-dimensional US-guided system (96%) was equivalent to that of expert radiologists using two-dimensional freehand US guidance (94.5%) in tissue phantoms containing poly(vinyl alcohol) cryogel lesions. CONCLUSION: This evaluation procedure is a valuable precursor to clinical trials in the assessment of biopsy techniques. The three-dimensional US-guided breast biopsy system provides a suitable alternative to two-dimensional freehand US guidance for biopsy of breast cancer.