Soo Adrianne E, Shelby Rebecca A, Miller Lauren S, Balmadrid Melissa Hayes, Johnson Karen S, Wren Anava A, Yoon Sora C, Keefe Francis J, Soo Mary Scott
University of North Carolina School of Medicine, Chapel Hill, North Carolina.
Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina.
J Am Coll Radiol. 2014 Jul;11(7):709-16. doi: 10.1016/j.jacr.2014.01.013.
The purpose of this study was to evaluate pain experienced during imaging-guided core-needle breast biopsies and to identify factors that predict increased pain perception during procedures.
In this institutional review board-approved, HIPAA-compliant protocol, 136 women undergoing stereotactically or ultrasound-guided breast biopsy or cyst aspiration were recruited and provided written informed consent. Participants filled out questionnaires assessing anticipated biopsy pain, ongoing breast pain, pain experienced during biopsy, catastrophic thoughts about pain during biopsy, anxiety, perceived communication with the radiologist, chronic life stress, and demographic and medical information. Procedure type, experience level of the radiologist performing the biopsy, number of biopsies, breast density, histology, and tumor size were recorded for each patient. Data were analyzed using Spearman's ρ correlations and a probit regression model.
No pain (0 out of 10) was reported by 39.7% of women, mild pain (1-3 out of 10) by 48.5%, and moderate to severe pain (≥4 out of 10) by 11.8% (n = 16). Significant (P < .05) predictors of greater biopsy pain in the probit regression model included younger age, greater prebiopsy breast pain, higher anticipated biopsy pain, and undergoing a stereotactic procedure. Anticipated biopsy pain correlated most strongly with biopsy pain (β = .27, P = .004).
Most patients report minimal pain during imaging-guided biopsy procedures. Women experiencing greater pain levels tended to report higher anticipated pain before the procedure. Communication with patients before biopsy regarding minimal average pain reported during biopsy and encouragement to make use of coping strategies may reduce patient anxiety and anticipated pain.
本研究旨在评估影像引导下的乳腺粗针穿刺活检过程中所经历的疼痛，并确定预测该过程中疼痛感知增加的因素。
在这项经机构审查委员会批准且符合健康保险流通与责任法案（HIPAA）的方案中，招募了136名接受立体定向或超声引导下乳腺活检或囊肿抽吸的女性，并获得了她们的书面知情同意。参与者填写问卷，评估预期的活检疼痛、持续的乳房疼痛、活检过程中经历的疼痛、活检过程中对疼痛的灾难性想法、焦虑、与放射科医生的沟通感受、慢性生活压力以及人口统计学和医学信息。记录每位患者的手术类型、进行活检的放射科医生的经验水平、活检次数、乳腺密度、组织学和肿瘤大小。使用斯皮尔曼等级相关系数（Spearman's ρ）和概率单位回归模型进行数据分析。
39.7%的女性报告无疼痛（0/10），48.5%报告轻度疼痛（1 - 3/10），11.8%（n = 16）报告中度至重度疼痛（≥4/10）。概率单位回归模型中，活检疼痛加剧的显著（P <.05）预测因素包括年龄较小、活检前乳房疼痛较重、预期活检疼痛较高以及接受立体定向手术。预期活检疼痛与活检疼痛的相关性最强（β =.27，P =.004）。
大多数患者在影像引导活检过程中报告疼痛轻微。经历较高疼痛水平的女性在手术前往往报告更高的预期疼痛。活检前与患者沟通关于活检期间报告的平均疼痛轻微情况，并鼓励其采用应对策略，可能会减轻患者的焦虑和预期疼痛。
