CT-guided biopsy of breast lesions: When should it be considered?

Mammography, ultrasound, and magnetic resonance imaging (MRI) are the most commonly used modalities for interventional radiology procedures involving the breast. Computed tomography (CT) is rarely used for breast imaging yet it is able to detect breast lesions and can often provide safe and effective access to breast lesions. The aim of this study was to demonstrate situations in which CT should be considered as an alternative guidance method for the biopsy of breast lesions that are not accessible with conventional imaging modalities.

Role of computed tomography at a cancer center emergency department.

To evaluate the imaging methods used at the emergency department (ED) of a cancer center, with emphasis on computed tomography (CT). A descriptive, retrospective, single-center study was conducted by reviewing imaging exams and medical records, after approval of the institution's Ethics Review Board. The demographic data, cancer history, and imaging exam requested were evaluated for all patients and the indications and results of head, chest, and abdominopelvic CT scans were also evaluated. During the study period, there were 8710 visits to the ED, and 5999 imaging studies were requested in 3788 patients (43.5 % of total of visits). One thousand eight hundred twenty-nine CT exams were used in 1121 visits (12.9 % of total of visits). The mean age of patients was 57.7 years and most patients (93.2 %) had a known primary tumor. The most common indications for abdominopelvic CT were non-oncologic emergencies (26.7 %) and postoperative complications (19.2 %), and the results were negative in 36.6 %, positive for clinical suspicion in 49.0 %, and incidental positive in 14.5 %. The most frequent indication for chest CT was suspected pulmonary embolism (34.4 %); however, only 11.1 % confirmed the diagnosis. The results of head TC were negative in 72.9 % and the indications that had more positive findings were suspected metastasis (32.1 %) and focal neurological sign/altered level of consciousness (24.5 %). CT plays an important role in driving the cancer patients visiting the ED. However, the high rate of negative or discordant results causes a concern for the inadvertent and excessive use of this imaging modality.

Safety and efficacy of HepaSphere 50-100 µm in the treatment of hepatocellular carcinoma.

AIM: To evaluate the effects of HepaSphere 50-100 µm (Merit Medical) as a doxorubicin carrier and embolization agent for the treatment of hepatocellular carcinoma (HCC). MATERIAL AND METHODS: A prospective analysis of 18 patients recruited from a national cancer center was conducted. This analysis evaluated the efficacy and safety of HepaSphere, as expressed by the treatment response rate (measured by the modified Response Evaluation Criteria in Solid Tumors, mRECIST) and by the prevalence of treatment-related adverse events, respectively. RESULTS: The cohort was predominantly male, with a mean age of 69 years. The objective response rate (complete + partial response) was 53.3%. The variable most likely to be associated with objective response was Barcelona Clinic Liver Cancer (BCLC) staging. The most prevalent adverse events were nausea, vomiting and abdominal pain. CONCLUSION: HepaSphere chemoembolization yielded a substantial objective response rate with an acceptable toxicity profile and should be considered an option for HCC treatment.

Breast Imaging Reporting and Data System (BI-RADS®): a success history and particularities of its use in Brazil.

BI-RADS® is a standardization system for breast imaging reports and results created by the American College of Radiology to initially address the lack of uniformity in mammography reporting. The system consists of a lexicon of descriptors, a reporting structure with final categories and recommended management, and a structure for data collection and auditing. It is accepted worldwide by all specialties involved in the care of breast diseases. Its implementation is related to the Mammography Quality Standards Act initiative in the United States (1992) and breast cancer screening. After its initial creation in 1993, four additional editions were published in 1995, 1998, 2003 and 2013. It is adopted in several countries around the world and has been translated into 6 languages. Successful breast cancer screening programs in high-income countries can be attributed in part to the widespread use of BI-RADS®. This success led to the development of similar classification systems for other organs (e.g., lung, liver, thyroid, ovaries, colon). In 1998, the structured report model was adopted in Brazil. This article highlights the pioneering and successful role of BI-RADS®, created by ACR 30 years ago, on the eve of publishing its sixth edition, which has evolved into a comprehensive quality assurance tool for multiple imaging modalities. And, especially, it contextualizes the importance of recognizing how we are using BI-RADS® in Brazil, from its implementation to the present day, with a focus on breast cancer screening.

Fungal infection mimicking pulmonary malignancy: clinical and radiological characteristics.

OBJECTIVE: The purpose of this study was to evaluate the clinical and radiological features of patients with fungal infection mimicking thoracic malignancy and to establish a diagnostic approach for both clinicians and radiologists to avoid misdiagnosis. METHODS: In this retrospective study, we reviewed clinical and computed tomography (CT) findings from 27 patients who presented with suspicion of thoracic malignancy who were ultimately diagnosed with fungal disease. RESULTS: Patients' median age was 55.7 (range 31-78) years. The most common clinical findings were cough (48.1 %), expectoration (33.3 %), chest pain (25.9 %), weakness (25.9 %), weight loss (18.5 %), and hemoptysis, dyspnea, and fever (7.4 % each). The median lesion size was 35.5 (range 10-85) mm. CT findings included a solid nodule (51.9 %), solid mass (37 %), or both (11.1 %). Nodule and mass margins were lobulated in 9 (33.3 %) patients, ill-defined in 5 (18.5 %), spiculated in 4 (14.8 %), and smooth in 4 (14.8 %) patients. Additional findings included consolidation in 4 (14.8 %) patients, cavitation in 3 (11.1 %), pleural effusion in 2 (7.4 %), and lymphadenopathy in 11 (40.7 %) patients. In all patients, specific diagnoses were made and confirmed by histopathology; final diagnoses were histoplasmosis (25.9 %), coccidiomycosis (22.2 %), cryptococcosis (22.2 %), aspergillosis (14.8 %), North American blastomycosis (7.4 %), mucormycosis (3.75 %), and paracoccidioidomycosis (3.75 %). CONCLUSIONS: Fungal infection can present with clinical and radiological features that are indistinguishable from thoracic malignancy, such as lung nodules or masses. Because the management and outcomes of fungal infection and malignancy are entirely distinct, the establishment of a specific diagnosis is critical to provide appropriate therapy.

Vacuum-assisted excision of breast lesions in surgical de-escalation: where are we?

Vacuum-assisted excision of breast lesions has come to be widely used in clinical practice. Increased acceptance and availability of the procedure, together with the use of larger needles, has allowed the removal of a greater amount of sample, substantially reducing the surgical upgrade rate and thus increasing the reliability of the results of the procedure. These characteristics result in the potential for surgical de-escalation in selected cases and gain strength in a scenario in which the aim is to reduce costs, as well as the rates of underestimation and overtreatment, without compromising the quality of patient care. The objective of this article is to review the technical parameters and current clinical indications for performing vacuum-assisted excision of breast lesions.

A excisão assistida a vácuo de lesões mamárias tem sido cada vez mais utilizada na prática clínica. A sua maior aceitação e disponibilidade, em associação ao uso de agulhas mais calibrosas, permitiu a retirada de quantidade maior de amostra, reduzindo substancialmente a taxa de subestimação diagnóstica e aumentando, assim, a confiabilidade final dos resultados do procedimento. Essas características resultam em potencial descalonamento cirúrgico, em casos selecionados, e ganham força em um cenário em que se visa a redução de custos, taxa de subestimação e tratamento excessivo, porém, sem comprometer a qualidade no cuidado com o paciente. O objetivo deste trabalho é revisar os parâmetros técnicos e as indicações clínicas atuais para realização de excisão assistida a vácuo em lesões mamárias.

Preoperative evaluation of sarcopenia in patients with colorectal cancer: a prospective study.

OBJECTIVE: Colorectal cancer is the third most diagnosed malignant neoplasm in the world and the fourth leading cause of cancer mortality. The loss of muscle mass in oncological patients is the main aspect of cancer-related malnutrition. Associations between sarcopenia and poor outcomes, such as high postoperative mortality, chemotherapy toxicity, and reduced survival, have been recently described. The aim of this study was to prospectively assess the prevalence of preoperative sarcopenia in patients with colorectal cancer using validated methods to evaluate muscle strength, muscle mass, and physical performance. METHODOLOGY: This study included patients with colorectal cancer undergoing oncological staging at a Cancer Center in Brazil from May 2019 to March 2020 who had images from abdominal computed tomography available for analysis of body composition. The muscle strength test, physical performance, referred fatigue, and clinical and nutritional data were evaluated. RESULTS: A total of 31 patients were included, and most were diagnosed with colon cancer (77.4%) and clinical stage II in 41.9% of cases. The prevalence of probable sarcopenia was 22.6%; of these patients, sarcopenia was confirmed in 19.4%, and ultimately, 9.7% of the sample was classified as severe sarcopenia. We did not find a significant association between the presence of sarcopenia in our sample and age, sex, tumor staging, nutritional characteristics, referred patient fatigue, or postoperative complications. CONCLUSION: Considering the criteria established by the EWGSOP, the prevalence of preoperative sarcopenia in colorectal cancer patients was 19.4%.

Breast cancer after thoracic radiotherapy in young patients: what does the radiologist need to know?

Radiation-induced secondary tumors constitute a rare complication of radiation therapy and typically occur in or near the irradiated area. Women who undergo thoracic radiotherapy before 30 years of age have a significantly greater lifetime risk of developing breast cancer than do those in the general population. It is recommended that a patient who has previously received thoracic radiotherapy with a radiation dose ≥ 10 Gy subsequently undergo annual screening with mammography and magnetic resonance imaging, beginning eight years after the initial treatment or when the patient has reached 25 years of age (whichever comes later). The treatment of secondary breast cancer in this population should be individualized and should be discussed with a multidisciplinary team to avoid toxicity related to the treatment of the primary cancer.

Os cânceres secundários induzidos por radiação são complicações raras da radioterapia e geralmente ocorrem na área tratada ou próximo a ela. Mulheres com menos de 30 anos de idade tratadas com radioterapia torácica têm risco significativamente aumentado de desenvolver câncer de mama ao longo da vida, em comparação com a população em geral. Para as pacientes tratadas com irradiação torácica com dose igual ou superior a 10 Gy é recomendado rastreamento anual com mamografia e ressonância magnética iniciando oito anos após o tratamento, desde que este início seja após 25 anos de idade. O tratamento do câncer de mama secundário nessa população deve ser individualizado e discutido com equipe multidisciplinar, para evitar toxicidade relacionada ao tratamento do câncer primário.

A Stochastic Grammar Approach to Mass Classification in Mammograms.

Breast cancer is responsible for approximately 15% of all cancer-related deaths among women worldwide, and early and accurate diagnosis increases the chances of survival. Over the last decades, several machine learning approaches have been used to improve the diagnosis of this disease, but most of them require a large set of samples for training. Syntactic approaches were barely used in this context, although it can present good results even if the training set has few samples. This article presents a syntactic approach to classify masses as benign or malignant. There were used features extracted from a polygonal representation of masses combined with a stochastic grammar approach to discriminate the masses found in mammograms. The results were compared with other machine learning techniques, and the grammar-based classifiers showed superior performance in the classification task. The best accuracies achieved were from 96% to 100%, indicating that grammatical approaches are robust and able to discriminate the masses even when trained with small samples of images. Syntactic approaches could be more frequently employed in the classification of masses, since they can learn the pattern of benign and malignant masses from a small sample of images achieving similar results when compared to the state of art.

Application of artificial intelligence in predicting malignancy risk in breast masses on ultrasound.

Objective: To evaluate the results obtained with an artificial intelligence-based software for predicting the risk of malignancy in breast masses from ultrasound images. Materials and Methods: This was a retrospective, single-center study evaluating 555 breast masses submitted to percutaneous biopsy at a cancer referral center. Ultrasonographic findings were classified in accordance with the BI-RADS lexicon. The images were analyzed by using Koios DS Breast software and classified as benign, probably benign, low to intermediate suspicion, high suspicion, or probably malignant. The histological classification was considered the reference standard. Results: The mean age of the patients was 51 years, and the mean mass size was 16 mm. The radiologist evaluation had a sensitivity and specificity of 99.1% and 34.0%, respectively, compared with 98.2% and 39.0%, respectively, for the software evaluation. The positive predictive value for malignancy for the BI-RADS categories was similar between the radiologist and software evaluations. Two false-negative results were identified in the radiologist evaluation, the masses in question being classified as suspicious by the software, whereas four false-negative results were identified in the software evaluation, the masses in question being classified as suspicious by the radiologist. Conclusion: In our sample, the performance of artificial intelligence-based software was comparable to that of a radiologist.

Objetivo: O objetivo deste trabalho foi avaliar os resultados de um software baseado em algoritmo de inteligência artificial para predição do risco de malignidade em nódulos mamários. Materiais e Métodos: Estudo retrospectivo e unicêntrico que avaliou 555 nódulos mamários submetidos a biópsia percutânea em um centro de referência oncológico. Os achados ultrassonográficos foram classificados de acordo com o léxico do BI-RADS. As imagens foram analisadas pelo software Koios DS Breast e divididas em benigna ou provavelmente benigna, suspeita baixa ou intermediária, suspeita alta ou provavelmente maligna. O resultado histopatológico foi considerado como padrão ouro. Resultados: A média de idade das pacientes foi de 51 anos e o tamanho médio dos nódulos foi de 16 mm. A sensibilidade e a especificidade foram de 99,1% e 34,0% para o radiologista e 98,2% e 39,0% para o software, respectivamente. O valor preditivo positivo para malignidade para as categorias BIRADS foi semelhante para o radiologista e para o software. Foram identificados dois resultados falso-negativos na avaliação pelo radiologista que foram classificados como suspeitos pelo software, e quatro resultados falso-negativos na avaliação pelo software que foram classificados como suspeitos pelo radiologista. Conclusão: Na nossa amostra, o software de inteligência artificial demonstrou resultados comparáveis à avaliação pelo radiologista.

Analysis of muscle mass by computed tomography in patients with head and neck cancer: a prospective study.

Objective: To evaluate the preoperative muscle mass of patients with head and neck cancer (HNC) with computed tomography (CT), comparing the results obtained through analysis of cross-sectional areas at the level of the third lumbar vertebra (L3) with those obtained through analysis of cross-sectional areas at the levels of the third cervical and fourth thoracic vertebrae (C3 and T4, respectively). Materials and Methods: A total of 63 patients with HNC were evaluated preoperatively. Using CT, we assessed muscle mass at L3, as well as at C3 and T4. Results: Most (73.0%) of the patients had low muscle mass at L3, whereas 50.8% had a normal body mass index. The cross-sectional area at L3 correlated strongly with those at C3 and T4 (r = 0.831 and r = 0.763, respectively; p < 0.001 for both). In addition, the muscle mass index at L3 correlated strongly with those at C3 and T4 (r = 0.781 and r = 0.715, respectively; p < 0.001 for both). Conclusion: Low muscle mass appears to be highly prevalent in patients with HNC. Measurements at C3 and T4 could represent alternative means of assessing muscle mass in such patients.

Objetivo: Avaliar e comparar a massa muscular de pacientes com câncer de cabeça e pescoço (CCP) durante o período pré-operatório com tomografia computadorizada (TC), por meio da análise das áreas transversais no nível da terceira vértebra lombar (L3) em comparação com níveis cervical (C3) e torácico (T4). Materiais e Métodos: Sessenta e três pacientes com CCP foram avaliados no pré-operatório. A TC foi utilizada para avaliar a massa muscular de L3, assim como as secções transversais de C3 e T4. Resultados: A maioria dos pacientes (73,0%) tinha baixa massa muscular analisada pela TC de L3, mas índice de massa corpórea normal (50,8%). Também foi observada forte correlação entre as áreas e o índice de massa muscular (IMM) de L3 com C3 (área: r = 0,831, p < 0,001; IMM: r = 0,781, p < 0,001) e T4 (área: r = 0,763, p < 0,001; IMM: r = 0,715, p < 0,001). Conclusão: A baixa massa muscular é altamente prevalente em pacientes com CCP. As análises de TC em C3 e T4 podem representar opção para avaliar a massa muscular em pacientes com CCP.

Impact of preoperative body composition in patients with renal cell carcinoma submitted to surgical treatment.

Objective: To evaluate the impact of preoperative body composition in patients with renal cell carcinoma (RCC) undergoing surgical treatment. Materials and Methods: This was a retrospective study of 52 patients with RCC undergoing total or partial nephrectomy. Body composition assessment was performed using the body mass index, together with computed tomography analysis at the level of the third lumbar vertebra to measure the area of visceral adipose tissue, as well as the area and density of skeletal muscle mass. Results: Malnutrition, obesity and inadequate skeletal muscle gauge (SMG) were associated with higher hospital length of stay (p = 0.028, p = 0.02 and p = 0.012, respectively). Although the rates of postoperative symptoms and readmissions were low, survival was better among the patients with an adequate SMG than among those with an inadequate SMG (p = 0.003). Conclusion: Among patients with RCC undergoing surgical treatment, preoperative body composition does not seem to be associated with the rates of perioperative complications, although an inadequate SMG seems to be associated with worse overall survival.

Objetivo: Avaliar o impacto da composição corporal pré-operatória em pacientes portadores de carcinoma de células renais (CCR) submetidos a tratamento cirúrgico. Materiais e Métodos: Foi realizado estudo retrospectivo de 52 pacientes portadores de CCR submetidos a tratamento cirúrgico. A avaliação da composição corporal foi realizada por meio do índice de massa corporal e análise da L3 obtida pela tomografia computadorizada para mensurar a área do tecido adiposo visceral, área e densidade da massa muscular esquelética. Resultados: Os pacientes desnutridos, obesos e que apresentaram produto muscular esquelético (PME) inadequado permaneceram mais tempo internados (p = 0,028, p = 0,02 e p = 0,012, respectivamente). As taxas de sintomas e reinternações no pósoperatório foram baixas em toda a amostra, no entanto, observou-se que pacientes com PME inadequado apresentaram uma pior sobrevida em relação aos pacientes com PME adequado (p = 0,003). Conclusão: A análise da composição corporal pré-operatória não mostrou associação com as taxas de complicações periope-ratórias em pacientes portadores de CCR submetidos a nefrectomia total ou parcial, no entanto, a inadequação do PME está associada a uma pior sobrevida.

Are we ready to stratify BI-RADS 4 lesions observed on magnetic resonance imaging? A real-world noninferiority/equivalence analysis.

Objective: To demonstrate that positive predictive values (PPVs) for suspicious (category 4) magnetic resonance imaging (MRI) findings that have been stratified are equivalent to those stipulated in the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) for mammography and ultrasound. Materials and Methods: This retrospective analysis of electronic medical records generated between January 4, 2016 and December 29, 2021 provided 365 patients in which 419 suspicious (BI-RADS category 4) findings were subcategorized as BI-RADS 4A, 4B or 4C. Malignant and nonmalignant outcomes were determined by pathologic analyses, follow-up, or both. For each subcategory, the level 2 PPV (PPV2) was calculated and tested for equivalence/noninferiority against the established benchmarks. Results: Of the 419 findings evaluated, 168 (40.1%) were categorized as malignant and 251 (59.9%) were categorized as nonmalignant. The PPV2 for subcategory 4A was 14.2% (95% CI: 9.3-20.4%), whereas it was 41.2% (95% CI: 32.8-49.9%) for subcategory 4B and 77.2% (95% CI: 68.4-84.5%) for subcategory 4C. Multivariate analysis showed a significantly different cancer yield for each subcategory (p < 0.001). Conclusion: We found that stratification of suspicious findings by MRI criteria is feasible, and malignancy probabilities for sub-categories 4B and 4C are equivalent to the values established for the other imaging methods in the BI-RADS. Nevertheless, low suspicion (4A) findings might show slightly higher malignancy rates.

Objetivo: Demonstrar que os valores preditivos positivos (VPPs) para lesões suspeitas (categoria 4) identificadas por ressonância magnética (RM) são equivalentes aos estipulados no ACR BI-RADS para mamografia e ultrassonografia. Materiais e Métodos: Análise retrospectiva de dados em prontuário eletrônico, entre 4 de janeiro de 2016 e 29 de dezembro de 2021, resultou em 365 pacientes elegíveis, com 419 lesões classificadas como BI-RADS 4A, 4B ou 4C. Desfechos malignos e não malignos foram determinados por estudo patológico e/ou acompanhamento. Realizamos o cálculo do VPP nível 2 (VPP2) para cada subcategoria e testamos para não inferioridade/equivalência em relação aos valores de referência. Resultados: Dos 419 achados, 168 (40,1%) foram malignos e 251 (59,9%), não malignos. O VPP2 para subcategoria 4A foi 14,2% (IC 95%: 9,3­20,4%), para 4B foi 41,2% (IC 95%:, 32,8­49,9%) e para 4C foi 77,2% (IC 95%: 68,4­84,5%). Análise multivariada demonstrou diferenças estatisticamente significantes entre as subcategorias (p < 0,001). Conclusão: A estratificação de achados suspeitos por RM é factível, sendo que a probabilidade de malignidade das subcategorias 4B e 4C é equivalente à estabelecida para outros métodos de imagem pelo BI-RADS. Contudo, lesões de baixa suspeição (4A) podem apresentar taxas mais altas de malignidade.

68Ga-DOTATATE PET/CT versus 111In-octreotide scintigraphy in patients with neuroendocrine tumors: a prospective study.

OBJECTIVE: To compare 68Ga-DOTA-DPhe1,Tyr3-octreotate (68Ga-DOTATATE) positron-emission tomography/computed tomography (PET/CT) findings with those of conventional 111In-octreotide scintigraphy in patients with neuroendocrine tumors (NETs). MATERIALS AND METHODS: This was a single-center prospective study including 41 patients (25 males; mean age, 55.4 years) with biopsy-proven NETs who underwent whole-body 111In-octreotide scintigraphy and whole-body 68Ga-DOTATATE PET/CT. The patients had been referred for tumor staging (34.1%), tumor restaging (61.0%), or response evaluation (4.9%). Images were compared in a patient-by-patient analysis to identify additional lesions, and we attempted to determine the impact that discordant findings had on treatment planning. RESULTS: Compared with 111In-octreotide scintigraphy, 68Ga-DOTATATE PET/CT revealed more lesions, the additional lesions typically being in the liver or bowel. Changes in management owing to the additional information provided by 68Ga-DOTATATE PET/CT occurred in five patients (12.2%), including intermodal changes in three (7.3%) and intramodal changes in two (4.9%). In addition, 68Ga-DOTATATE PET/CT yielded incidental findings unrelated to the primary NET in three patients (7.3%): Hürthle cell carcinoma of the thyroid, bowel non-Hodgkin lymphoma, and a suspicious breast lesion. CONCLUSION: We conclude that 68Ga-DOTATATE PET/CT is superior to conventional 111In-octreotide scintigraphy for the management of NETs because of its ability to determine the extent of the disease more accurately, which, in some cases, translates to changes in the treatment plan.

OBJETIVO: Comparar os achados da PET/CT com 68Ga-DOTATATE em relação aos da cintilografia com 111In-octreotide em pacientes com tumores neuroendócrinos (TNEs). MATERIAIS E MÉTODOS: Estudo prospectivo unicêntrico incluindo 41 pacientes (25 homens; média de idade: 55,4 anos) com TNEs comprovados por biópsia submetidos a cintilografia de corpo inteiro com 111In-octreotide e PET/CT com 68Ga-DOTATATE. Os pacientes incluídos foram encaminhados para estadiamento do tumor (34,1%), reestadiamento (61,0%) ou avaliação da resposta (4,9%). As imagens foram comparadas para identificar lesões adicionais e o impacto dos achados discordantes no planejamento terapêutico. RESULTADOS: Na comparação com a cintilografia com 111In-octreotide, a PET/CT com 68Ga-DOTATATE revelou mais lesões, mais frequentemente localizadas no fígado e intestino. Mudanças no tratamento devidas às informações adicionais reveladas pela PET/ CT ocorreram em 5/41 pacientes (12,2%), incluindo mudanças intermodalidade em três casos (7,3%) e intramodalidade em dois casos (4,9%). A PET/CT também identificou achados incidentais não relacionados ao TNE em 3/41 pacientes (7,3%), incluindo um carcinoma de células de Hürthle da tireoide, um linfoma não Hodgkin de intestino e uma lesão mamária suspeita. CONCLUSÃO: A PET/CT com 68Ga-DOTATATE é superior à cintilografia convencional com 111In-octreotide para o manejo de pacientes com TNEs, em virtude da sua capacidade de detectar a extensão da doença com mais precisão, o que se traduz, em alguns casos, em alterações terapêuticas.

Relationship between anxiety and internet searches before percutaneous ultrasound-guided diagnostic procedures: A prospective cohort study.

Invasive procedures guided by ultrasound (US) are part of routine medical diagnostic investigation. The lack of knowledge surrounding the technical aspects of such procedures can lead patients to seek complementary information on the Internet, which may in turn trigger anxiety. However, the intersection between the fields of Radiology and Psychology is poorly studied. Here, we identify the profile of an anxious patient before an US-guided intervention. We prospectively studied 133 patients undergoing image-guided procedures. The State-Trait Anxiety Inventory (STAI) was applied for psychometry. Significantly higher anxiety scores were observed in female patients (p = .001), those who believed they had received inadequate information from their referring physician (p = .006), and in patients who considered online information unreliable or difficult to access (p = .007 and p = .001, respectively). Participants who defined themselves as proactive online reported lower anxiety levels (p = .003).