Strategy for Diagnosing Breast Cancer in Indonesia during the COVID-19 Pandemic: Switching to Ultrasound-Guided Percutaneous Core Needle Biopsy

Farida Briani Sobri, Adang Bachtiar, Sonar Soni Panigoro, Juwita Cresti Rahmaania, Patria Wardana Yuswar, Ening Krisnuhoni, Nelly Tandiari

Abstract


In this era of COVID-19, suspected breast cancer patients experience delay in diagnosis due to the fear of contracting the virus and reduction of non-COVID-19 health services. Furthermore, it may lead to potential increase in the incidence of advanced cancers in the future. Ultrasound-guided (US-guided) percutaneous core needle biopsy (CNB) is a great option for the diagnosis of cancer but it is poorly utilized. This study aimed to prove that the US-guided CNBis accurate when performed in a local setting and a potential solution for diagnosing breast cancer patients in this pandemic. In addition, it was a single health center cross-sectional study, and the participants were all breast cancer patients that had US-guided CNB from 2013-2019. The pathology results from US-guided CNB were compared to specimens from post-CNB surgeries. The data were collected from medical records and the immunohistochemistry (IHC) examinations were carried out for malignancy. There were 163 patients who were included in this study, 86 had malignancies and 77 had benign tumor reported in their CNB results. The US-guided CNB had 100% sensitivity and specificity compared to surgery. With its lower cost, time usage, and patient exposure to the hospital environment, US-guided CNB should replace open surgery biopsy for diagnosing suspicious breast cancers during the pandemic in Indonesia.

Keywords


breast cancer, core needle biopsy, COVID-19, health cost, resources

Full Text:

PDF

References


 1. Globocan Observatory W. Cancer today - world. International Agency for Research on Cancer. 2019; 876: 2018–9.

 2. Youlden DR, Cramb SM, Yip CH, Baade PD. Incidence and mortality of female breast cancer in the Asia-Pacific region. Cancer Biology & Medicine. 2014;11 (2): 101–15.

 3. Al‐Shamsi HO, Alhazzani W, Alhuraiji A, Coomes EA, Chemaly RF, Almuhanna M, et al. A practical approach to the management of cancer patients during the novel coronavirus disease 2019(COVID‐19) pandemic: an international collaborative group. The Oncologist. 2020; 25 (6).

 4. Rocco N, Montagna G, Micco R, Benson J, Criscitiello C, Chen L, etal. The impact of the COVID‐19 pandemic on surgical management of breast cancer: global trends and future perspectives. The Oncologist. 2021; 26 (1).

 5. Çitgez B. Management of breast cancer during the COVID-19 pandemic. Medical Bulletin of Sisli Etfal Hospital; 2020.

 6. Amit M, Tam S, Bader T, Sorkin A, Benov A. Pausing cancer screening during the severe acute respiratory syndrome coronavirus 2 pandemic: Should we revisit the recommendations? European Journal of Cancer. 2020; 134: 86–9.

 7. You K, Park S, Ryu JM, Kim I, Lee SK, Yu J, et al. Comparison of core needle biopsy and surgical specimens in determining intrinsic biological subtypes of breast cancer with immunohistochemistry. Journal of Breast Cancer. 2017; 20 (3): 297.

 8. Dahabreh IJ, Wieland LS Adam GP, Halladay C, Lau J, Trikalinos TA. Core needle and open surgical biopsy for diagnosis of breast lesions: an update to the 2009 report. Rockville (MD): Agency for Healthcare Research and Quality (US); 2014.

 9. Duggan C, Dvaladze A, Rositch AF, Ginsburg O, Yip C, Horton S, et al. The breast health global initiative 2018 global summit on improving breast healthcare through resource‐stratified phased implementation: methods and overview. Cancer. 2020; 126 (S10): 2339–52.

 10. American Joint Comittee on Cancer. AJCC cancer staging manual. 8thed. Chicago: American Joint Comittee on Cancer; 2016.

 11. Apesteguía L, Pina LJ. Ultrasound-guided core-needle biopsy of breast lesions. Insights Imaging. 2011; 2 (4): 493–500.

 12. Guo R, Lu G, Qin B, Fei B. Ultrasound imaging technologies for breast cancer detection and management: a review. Ultrasound in Medicine and Biology. 2018; 44 (1): 37–70.

 13. Perhimpunan Ahli Bedah Onkologi Indonesia (PERABOI). Protokol Peraboi 2020. 2nd ed. Jakarta: PERABOI; 2020.

 14. Wang M, He X, Chang Y, Sun G, Thabane L. A sensitivity and specificity comparison of fine-needle aspiration cytology and core needle biopsy in evaluation of suspicious breast lesions: a systematic review and meta-analysis. The Breast. 2017; 31: 157–66.

 15.Willems SM, van Deurzen CHM, van Diest PJ. Diagnosis of breast lesions: fine-needle aspiration cytology or core needle biopsy? A review. Journal of Clinical Pathology. 2012; 65 (4): 287–92.

 16. Bennett IC, Saboo A. The evolving role of vacuum-assisted biopsy of the breast: a progression from fine-needle aspiration biopsy. World Journal of Surgery. 2019; 43 (4): 1054–61.

 17. Park HS, Jeon CW. Learning curve for breast mass excision using a vacuum-assisted biopsy system. Minimally Invasive Therapy & Allied Technologies. 2014; 23 (4): 235–40.

 18.Rocha RD, Pinto RR, Tavares DPBA, Gonçalves CSA. Step-by-step of ultrasound-guided core-needle biopsy of the breast: review and technique. Radiol Bras. 2013; 46 (4): 234–41.

 19. Gradishar WJ, Anderson BO, Abraham J, Aft R, Agnese D, AllisonKH, et al. Breast cancer, version 3.2020, NCCN clinical practice guidelines in oncology. Journal of the National Comprehensive Cancer Network. 2020; 18 (4): 452–78.

 20. Senkus E, Kyriakides S, Ohno S, Penault-Llorca F, Poortmans P, Rutgers E, et al. Primary breast cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Annals of Oncology.2015; 26: v8–30.

 21. Gaur S, Dialani V, Slanetz PJ, Eisenberg RL. Architectural distortion of the breast. American Journal of Roentgenology. 2013; 201 (5): W662–70.

 22. Ambinder EB, Plotkin A, Euhus D, Mullen LA, Oluyemi E, Di Carlo P, et al. Tomosynthesis-guided vacuum-assisted breast biopsy of architectural distortion without a sonographic correlate: a retrospective review. American Journal of Roentgenology. 2020; 1-10.

 23. Balic M, Thomssen C, Würstlein R, Gnant M, Harbeck N. St.Gallen/Vienna 2019: a brief summary of the consensus discussion on the optimal primary breast cancer treatment. Breast Care. 2019; 14 (2): 103–10.

 24. Greenwood E, Swanton C. Consequences of COVID-19 for cancer care — a CRUK perspective. Nature Reviews Clinical Oncology. 2021;18 (1): 3–4.

 25. Fernández-García P, Marco-Doménech SF, Lizán-Tudela L, Ibáñez-Gual MV, Navarro-Ballester A, Casanovas-Feliu E. The cost effectiveness of vacuum-assisted versus core-needle versus surgical biopsy ofbreast lesions. Radiologia. 2017; 59 (1): 40–6.

 26.Klimberg VS, Rivere A. Ultrasound image-guided core biopsy of the breast. Chinese Clinical Oncology. 2016; 5 (3): 33.

 27. Badan Penyelenggara Jaminan Sosial Kesehatan. Data utilization review terkait kasus kanker. Jakarta: BPJS Kesehatan; 2020.

 28. Bennett I, de Viana D, Law M, Saboo A. Surgeon-performed vacuum-assisted biopsy of the breast: results from a multicentre Australian study. World Journal of Surgery. 2020; 44 (3): 819–24.

 29. Tikku G, Umap P. Comparative study of core needle biopsy and fine-needle aspiration cytology in palpable breast lumps: scenario in developing nations. Turkish Journal of Pathology. 2016; 32 (1): 1-7.

 30. Boland MR, Al-Maksoud A, Ryan ÉJ, Balasubramanian I, Geraghty J, Evoy D, et al. Value of a 21-gene expression assay on core biopsy to predict neoadjuvant chemotherapy response in breast cancer: systematic review and meta-analysis. British Journal of Surgery. 2021; 108 (1): 24–31.




DOI: http://dx.doi.org/10.21109/kesmas.v16i3.4359

Refbacks

  • There are currently no refbacks.