Impact of Simulation-Based Training on Radiology Trainee Education in Ultrasound-Guided Breast Biopsies.

PURPOSE: The aim of this study is to determine the impact of a simulation-based ultrasound-guided (USG) breast biopsy training session on radiology trainee procedural knowledge, comfort levels, and overall procedural confidence and anxiety. METHODS: Twenty-one diagnostic radiology residents from a single academic institution were recruited to participate in an USG breast biopsy training session. The residents filled out a questionnaire before and after the training session. Ten multiple-choice questions tested general knowledge in diagnostic breast ultrasound and USG breast biopsy concepts. Subjective comfort levels with ultrasound machine and biopsy device functionality, patient positioning, proper biopsy technique, image documentation, needle safety and overall procedural confidence and anxiety levels were reported on a 5-point Likert scale before and after training. RESULTS: Participants demonstrated significant improvement in number of correctly answered general knowledge questions after training (P < .0001). Significant improvement was seen in resident comfort level in ultrasound machine functionality, patient positioning, biopsy device functionality, biopsy technique, image documentation, as well as overall confidence level (all P < .05). Participants indicated a slight but not significant reduction in anxiety levels (P = .27). CONCLUSIONS: A simulation-based USG breast biopsy training session may improve radiology trainee procedural knowledge, comfort levels, and overall procedural confidence.

Granulomatous Mastitis in a Transgender Patient.

Granulomatous mastitis is a rare and benign inflammatory condition of the breast most commonly affecting women of child-bearing age as well as patients on oral contraceptives. This condition is important to identify due to its diagnostic mimicry of malicious entities such as breast carcinoma. Clinical and radiological findings are nonspecific and may overlap with breast carcinomas, thus pathologic confirmation is often necessary for definitive diagnosis. Although cases of granulomatous mastitis have been described in cisgender females, there have been no reported cases in the transgender patient, a growing patient population with few imaging guidelines. Transgender patients are at risk of developing this breast entity due to the use of long-term hormone treatments or presence of residual breast tissue. A trial of antibiotics or steroids may be administered. However, surgical treatment is often necessary in recurrent or refractory cases.

Stereotactic Biopsy of Segmental Breast Calcifications: Is Sampling of Anterior and Posterior Components Necessary?

RATIONALE AND OBJECTIVES: Core needle biopsy results of segmental calcifications on mammography can have direct impact on surgical management. Although dependent on breast size, cancer spanning greater than 5 cm is usually treated with mastectomy, and cancer less than 5 cm is managed with lumpectomy. Approach to stereotactic biopsy of morphologically similar segmental calcifications that span more than 5 cm on mammography varies geographically and is currently largely based on preference of the surgical or medical oncology colleagues. Some clinicians prefer biopsy of the anterior and posterior aspects of the abnormality, whereas others believe a single biopsy within the abnormality is adequate. There is insufficient data to support whether a single biopsy of calcifications is adequate to establish the need for mastectomy, or if pathology-proven cancer in the anterior and posterior components to define the extent of disease is required. This study aims to evaluate concordance rates of paired biopsies of suspicious segmental mammographic calcifications. MATERIALS AND METHODS: From a 5-year review of our imaging database, 32 subjects were identified with breast imaging reporting and data system (BI-RADS) 4 or 5 segmental calcifications on mammography who underwent anterior and posterior stereotactic biopsies. The paired biopsy results were independently analyzed for concordance on benign, high-risk, or malignant pathology. RESULTS: Of the 32 cases, there was perfect agreement (32/32 cases = 100% concordance, 95% confidence interval = 89.3-100%) in anterior and posterior pairs in benign, high-risk, or malignant findings (kappa = 1, P < 0.001). CONCLUSIONS: The absence of data on pathological concordance in anterior and posterior aspects of suspicious, morphologically similar, segmental calcifications spanning 5 cm or more has led to a varied clinical approach to stereotactic biopsy. The 100% rate of pathological concordance in our study suggests that a single biopsy is adequate for diagnosis and representative of the whole mammographic abnormality. Implementation of this approach will potentially reduce unnecessary biopsies and surgeries, minimize healthcare costs, and decrease patient morbidity.