Age affects short-term quality of life after breast biopsy
Breast biopsies can adversely affect short-term quality-of-life, and the effects are more pronounced in younger patients, according to a new study published online in the journal Radiology.
More than 500,000 women in the United States have a breast biopsy each year. In the percutaneous method, a physician uses a needle to remove several small samples from the area of interest for pathological analysis. Percutaneous biopsies are associated with fewer complications than the surgical approach, but there are still significant short-term side effects, including pain and emotional distress.
“Short-term experiences can have a long-term impact,” said Janie M. Lee, M.D., M.Sc., former staff radiologist at Massachusetts General Hospital (MGH) in Boston and assistant professor at Harvard. “If people have a less than positive experience during biopsy, then they might be less likely to come back for screening the next time they are due.”
To learn more about the impact of percutaneous biopsy, researchers at MGH surveyed women two to four days after the procedure. They used a tool called the Testing Morbidities Index (TMI), a survey that assesses short-term quality of life based on seven attributes, including pain/discomfort and fear/anxiety before and during the procedure, and physical and mental function afterwards.
The patients rated each characteristic on a scale of one to five, and the final score was adjusted to a scale ranging from 0 for the worst possible experience to 100 for no adverse quality-of-life effects.
The 188 women, ranging in age from 22 to 80 years, had a mean TMI score of 82 out of 100. Patient age was the only significant independent predictor of the TMI score, which decreased by approximately three points for every decade decrease in patient age. The mean TMI score for women less than 40 years old was 76.4.
What is a breast biopsy?
A breast biopsy is a procedure in which part or all of a suspicious breast growth is removed and examined, usually for the presence of cancer. The growth sample is suctioned out through a needle or cut out using a surgical procedure. The sample is then examined and evaluated under a microscope by a pathologist to identify non-cancerous (benign) or cancerous (malignant) tissue.
Words used to refer to the abnormal area or growth before and after diagnosis may include lump, mass, lesion, and tumor.
“The most important result from this study is that women have short-term decreases in quality of life related to breast biopsy,” said Dr. Lee, who has since moved to the University of Washington School of Medicine in Seattle, where she is associate professor of radiology, as well as the director of breast imaging at Seattle Cancer Care Alliance. “When we looked at the predictors of quality-of-life score, we found that the strongest predictor is younger age.”
Dr. Lee noted that the results are surprising at first glance, considering that younger women as a group generally are healthier than their older counterparts. She pointed to the significant role of anxiety as a major factor in explaining the differences.
“The prospect of life-threatening disease can produce a lot of anxiety in anyone,” Dr. Lee said. “Younger women typically have less experience with the health care system in general, and it may be their first time going through a diagnostic testing experience.”
Several breast biopsy procedures are used to obtain a tissue sample from the breast. Your doctor may recommend a particular procedure based on the size, location and other characteristics of the breast abnormality. If it’s not clear why you’re having one type of biopsy instead of another, ask your doctor to explain.
For many biopsies, you’ll get an injection to numb the area of the breast to be biopsied. Types of breast biopsy include:
Fine-needle aspiration biopsy. This is the simplest type of breast biopsy and may be used to evaluate a lump that can be felt during a clinical breast exam. For the procedure, you lie on a table. While steadying the lump with one hand, your doctor uses the other hand to direct a fine needle - more slender than that used to obtain a blood sample or tissue sample - into the lump.
The needle is attached to a syringe that can collect a sample of cells or fluid from the lump. Fine-needle aspiration is a quick way to distinguish between a fluid-filled cyst and a solid mass and, possibly, to avoid a more invasive biopsy procedure. If, however, the mass is solid, it will need further evaluation.
Core needle biopsy. This type of breast biopsy may be used to assess a breast lump that’s visible on a mammogram or ultrasound or that your doctor feels (palpates) during a clinical breast exam. A radiologist or surgeon uses a thin, hollow needle to remove tissue samples from the breast mass, most often using ultrasound guidance.
Several samples, each about the size of a grain of rice, are collected and analyzed to identify features indicating the presence of disease. Depending on the location of the mass, other imaging techniques, such as mammography or MRI, may be used to guide the positioning of the needle in a core needle biopsy depending on the location of the mass.
Stereotactic biopsy. This type of biopsy uses mammograms to pinpoint the location of suspicious areas within the breast. For this procedure, you generally lie facedown on a padded biopsy table with one of your breasts positioned in a hole in the table. You may need to remain in this position for 30 minutes to one hour.
The table is raised several feet, and the equipment used by the radiologist is positioned beneath the table. Your breast is firmly compressed between two plates while mammograms are taken to show the radiologist the exact location of the area for biopsy.
The radiologist makes a small incision - about 1/4-inch long (about 6 millimeters) - into your breast. He or she then inserts either a needle or a vacuum-powered probe and removes several samples of tissue. The samples are sent to a lab for analysis.
Ultrasound-guided core needle biopsy. This type of core needle biopsy involves ultrasound - an imaging method that uses high-frequency sound waves to produce precise images of structures within your body. During this procedure, you lie on your back or side on an ultrasound table.
Holding the ultrasound device (transducer) against your breast, the radiologist locates the mass within your breast, makes a small incision to insert the needle and takes several core samples of tissue to be sent to a lab for analysis.
MRI-guided core needle biopsy. This type of core needle biopsy is done under guidance of MRI - an imaging technique that captures multiple cross-sectional images of your breast and combines them, using a computer, to generate detailed 3-D pictures. During this procedure, you lie facedown on a padded scanning table. Your breasts fit into a hollow depression in the table.
The MRI machine provides images that help determine the exact location for the biopsy. A small incision of about 1/4-inch long (about 6 millimeters) is made to allow the core needle to be inserted. Several samples of tissue are taken and sent to a lab for analysis.
Surgical biopsy. During a surgical biopsy, a portion of the breast mass is removed for examination (incisional biopsy) or the entire breast mass may be removed (excisional biopsy, wide local excision or lumpectomy). A surgical biopsy is usually done in an operating room using sedation given through a vein in your hand or arm (intravenously) and a local anesthetic to numb your breast.
If the breast mass can’t be felt, your radiologist may use a technique called wire localization to map the route to the mass for the surgeon. During wire localization, the tip of a thin wire is positioned within the breast mass or just through it. This is usually done right before surgery.
During surgery, the surgeon will attempt to remove the entire breast mass along with the wire. To help ensure that the entire mass has been removed, the tissue is sent to the hospital lab to check the edges (margins) of the mass.
If cancer cells are present in the margins (positive margins), some cancer may still be in the breast, and more tissue must be removed. If the margins are clear (negative margins), then the cancer has been removed adequately.
The study findings suggest that tailored pre-biopsy counseling may better prepare women for percutaneous biopsy procedures.
“By better explaining what patients can expect during the biopsy experience, we can minimize anxiety before and after the procedure,” Dr. Lee said.
Researchers at MGH, led by Shannon Swan, M.D., are using the TMI tool to study other screening experiences like colonoscopy to learn ways to improve the diagnostic testing process for patients.
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“Percutaneous Breast Biopsy: Effect on Short-term Quality of Life.” Collaborating with Drs. Lee and Swan were Kathryn L. Humphrey, M.D., Karen Donelan, Sc.D., Chung Y. Kong, Ph.D., Olubunmi Williams, M.D., M.P.H., Omosalewa Itauma, M.D., M.P.H., Elkan F. Halpern, Ph.D., Beverly J. Gerade, N.P., and Elizabeth A. Rafferty, M.D.
Radiology is edited by Herbert Y. Kressel, M.D., Harvard Medical School, Boston, Mass., and owned and published by the Radiological Society of North America, Inc.
RSNA is an association of more than 53,000 radiologists, radiation oncologists, medical physicists and related scientists promoting excellence in patient care and health care delivery through education, research and technologic innovation. The Society is based in Oak Brook, Ill.
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Linda Brooks
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Radiological Society of North America