An audit of pain experienced during image-guided breast biopsy procedures at an academic center

Percutaneous image-guided biopsy plays an integral role in the management of breast lesions identified on imaging studies, with reported rates of up to 1%-8% of women enrolled in a screening mammography program undergoing percutaneous breast biopsy at some point in their care [1,2]. Depending on the characteristics of the lesion, biopsy techniques may vary in the type (ie, fine-needle aspiration [FNA], core needle [CNB], vacuum-assisted [VAB]) and in the modality used for imaging guidance (ultrasound [US], mammography, magnetic resonance imaging [MRI]). As with any invasive procedure, it is important to try to minimize the patient's overall discomfort and pain perception, and recognize what factors may contribute to this, especially as pain and discomfort may affect future adherence to screening [3]. Although a commonly performed procedure, previously published literature regarding the impact of various factors during image guided breast biopsy on the pain experience is scarce and somewhat discrepant. Pain scores were found to be operator-dependent by Denton et al [4], and more specifically operator experience showed an inverse correlation with pain scores in the study by Salem et al [5]. However several other studies did not demonstrate any influence on pain scores by operator [6,7] or their level of training [8]. Studies stratifying results by imaging modality and biopsy method have also been few and their conclusions variable. Satchithanada et al [7] reported that FNA was associated with significantly increased pain scores while Denton et al [4] did not report such an association. Additionally, no prior published studies have examined pain associated with MRI-guided biopsies. There is also little consensus with regards to the influence of age, breast density, and final pathology. The aim of our study was to evaluate the pain experienced by patients undergoing image-guided breast biopsy, and examine the association between pain and factors that included biopsy type, image guidance method, needle gauge, and preprocedural anxiety. Because of the relatively large number of trainees that rotate through the department and the emerging usage of MRI-guided biopsies, the analysis included data on operator experience and MR-guidance. (author)