Freehand Versus Guided Breast Biopsy: Comparison of Accuracy, Needle Motion, and Biopsy Time in a Tissue Model

Bluvol, Nathan; Kornecki, Anat; Shaikh, A.; Fernandez, David Del Rey; Taves, Donald H.; Fenster, Aaron

doi:10.2214/ajr.08.1434

Cited by 24 publications

(18 citation statements)

References 18 publications

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“…According to Memel et al, 8 the major challenge to performing a safe biopsy is real‐time needle visualization. Commercially available sonographic guides, which have a fixed angle, are inexpensive alternatives that may provide more confidence regarding the needle position inside the body when performing sonographically guided proce‐dures 2 due to the predetermined track of the needle based on the guide's angle line.…”

Section: Discussionmentioning

confidence: 99%

“…The two commonly used methods are the freehand and needle‐guided techniques. The guided technique depends on a fixed angle between the needle trajectory and the ultrasound probe 2 …”

mentioning

confidence: 99%

“…The guided technique depends on a fixed angle between the needle trajectory and the ultrasound probe. 2 Although the freehand technique potentially allows more versatility, the guided technique may provide a more predictable needle trajectory because it keeps the needle in the same plane while the needle is advanced toward the target. 2 Each technique has its advantages and limitations.…”

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confidence: 99%

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Accuracy of Sonographically Guided Biopsy Using a Freehand Versus Needle-Guided Technique

Shabana

Kielar

Vermani

et al. 2013

Journal of Ultrasound in Medicine

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Sonographically guided biopsy is performed by one of two techniques: the freehand and needle-guided techniques. To our knowledge, the relationship between the location of the local anesthetic tract and the biopsy needle tract as well as direct comparison of the two biopsy techniques has not been previously validated. The aim of this study was to validate the different parameters related to the two biopsy techniques using computed tomography as the reference standard for assessing final tract positions. There were statistically significant differences between the freehand and guided techniques in the following parameters: number of passes required for contrast agent injection (P = .003), number of passes required to insert the needle (P = .005), time required to inject the anesthetic/contrast agent (P = .005), time required to insert the biopsy needle (P = .02), and distance between contrast tract and final needle position (P = .03). No statistical difference was identified for the angle between the contrast tract and needle position. This difference likely reflects the confidence of the radiologist in identifying the needle location during the procedure. Using a commercially available guide that has a fixed angle can result in a faster, more efficient, and reproducible biopsy technique compared to the freehand technique, especially for those who have less experience in performing sonographically guided biopsies.

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Section: Discussionmentioning

confidence: 99%

“…The two commonly used methods are the freehand and needle‐guided techniques. The guided technique depends on a fixed angle between the needle trajectory and the ultrasound probe 2 …”

mentioning

confidence: 99%

mentioning

confidence: 99%

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Accuracy of Sonographically Guided Biopsy Using a Freehand Versus Needle-Guided Technique

Shabana

Kielar

Vermani

et al. 2013

Journal of Ultrasound in Medicine

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“…Conversely, the free-hand technique requires more operator expertise to see the needle tip in the ultrasound image. 17 In our study, identification of the interspace level by palpation rather than by ultrasound differed in only two of the 19 subjects. However, since previous studies 3 have suggested that palpation misidentifies the actual space in 58% of the cases, it is recommended that ultrasound guidance continue being used.…”

Section: Discussionmentioning

confidence: 54%

Single-operator real-time ultrasound-guidance to aim and insert a lumbar epidural needle

Tran

Kamani

Al-Attas

et al. 2010

Can J Anesth/J Can Anesth

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Purpose In conventional practice of epidural needle placement, determining the interspinous level and choosing the puncture site are based on palpation of anatomical landmarks, which can be difficult with some subjects. Thereafter, the correct passage of the needle towards the epidural space is a blind ''feel as you go'' method. An aim-and-insert single-operator ultrasound-guided epidural needle placement is described and demonstrated. Method Nineteen subjects undergoing elective Cesarean delivery consented to undergo both a pre-puncture ultrasound scan and real-time paramedian ultrasound-guidance for needle insertion. Following were the study objectives: to measure the success of a combined spinal-epidural needle insertion under real-time guidance, to compare the locations of the chosen interspinous levels as determined by both ultrasound and palpation, to measure the change in depth of the epidural space from the skin surface as pressure is applied to the ultrasound transducer, and to investigate the geometric limitations of using a fixed needle guide. Results One subject did not participate in the study because pre-puncture ultrasound examination showed unrecognizable bony landmarks. In 18 of 19 subjects, the epidural needle entered the epidural space successfully, as defined by a loss-of-resistance. In two subjects, entry into the epidural space was not achieved despite ultrasound guidance. Eighteen of the 19 interspinous spaces that were identified using palpation were consistent with those determined by ultrasound. The transducer pressure changed the depth of the epidural space by 2.8 mm. The measurements of the insertion lengths corresponded with the geometrical model of the needle guide, but the needle required a larger insertion angle than would be needed without the guide. Conclusion This small study demonstrates the feasibility of the ultrasound-guidance technique. Areas for further development are identified for both ultrasound software and physical design. RésuméObjectif Dans le positionnement traditionnel de l'aiguille pe´ridurale, l'identification du niveau intere´pineux et le choix du site de ponction se fondent sur la palpation de points de repe`re anatomiques, ce qui peut s'ave´rer difficile chez certains patients. Par la suite, le passage appropried e l'aiguille vers l'espace pe´ridural est re´alise´par une me´thode en aveugle sur la base de sensation subjective pendant l'insertion. Nous de´crivons et de´montrons ici le positionnement d'une aiguille pe´ridurale e´choguide´e par un ope´rateur unique en 'ciblant et inse´rant'. Méthode Dix-neuf patientes subissant un accouchement par ce´sarienne non urgent ont consenti a`subir un Electronic supplementary material The online version of this article (doi:10.1007/s12630-009-9252-1) contains supplementary material, which is available to authorized users.

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“…[32] In the literature on simulation-based training, similar bench models made from chicken parts postmortem have been previously used with different indications, such as legs for teaching how to change needle angles, microneurosurgical and microvascular surgery and bedsidedetection of glass in wounds;[33–35] thigh, wings, esophagus and trachea for microsurgical surgery training;[36–40] the gizzard, posterior trunks, crop and esophagus for laparoscopic training;[41–43] and others. [44-45]…”

Section: Discussionmentioning

confidence: 99%

Simulation-based cutaneous surgical-skill training on a chicken-skin bench model in a medical undergraduate program

2013

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Background:Because of ethical and medico-legal aspects involved in the training of cutaneous surgical skills on living patients, human cadavers and living animals, it is necessary the search for alternative and effective forms of training simulation.Aims:To propose and describe an alternative methodology for teaching and learning the principles of cutaneous surgery in a medical undergraduate program by using a chicken-skin bench model.Materials and Methods:One instructor for every four students, teaching materials on cutaneous surgical skills, chicken trunks, wings, or thighs, a rigid platform support, needled threads, needle holders, surgical blades with scalpel handles, rat-tooth tweezers, scissors, and marking pens were necessary for training simulation.Results:A proposal for simulation-based training on incision, suture, biopsy, and on reconstruction techniques using a chicken-skin bench model distributed in several sessions and with increasing levels of difficultywas structured. Both feedback and objective evaluations always directed to individual students were also outlined.Conclusion:The teaching of a methodology for the principles of cutaneous surgery using a chicken-skin bench model versatile, portable, easy to assemble, and inexpensive is an alternative and complementary option to the armamentarium of methods based on other bench models described.

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Freehand Versus Guided Breast Biopsy: Comparison of Accuracy, Needle Motion, and Biopsy Time in a Tissue Model

Cited by 24 publications

References 18 publications

Accuracy of Sonographically Guided Biopsy Using a Freehand Versus Needle-Guided Technique

Accuracy of Sonographically Guided Biopsy Using a Freehand Versus Needle-Guided Technique

Single-operator real-time ultrasound-guidance to aim and insert a lumbar epidural needle

Simulation-based cutaneous surgical-skill training on a chicken-skin bench model in a medical undergraduate program

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