title: Large-core breast biopsy: abnormal salivary cortisol profiles associated with uncertainty of diagnosis.
abstract: OBJECTIVE
  To determine whether uncertainty of the diagnosis after large-core breast biopsy (LCBB) adversely affects biochemical stress levels.
  
  
  METHODS
  This study was institutional review board approved and HIPAA compliant, and all patients gave written informed consent. One hundred fifty women aged 18-86 years collected four salivary cortisol samples per day for 5 days after LCBB. t Tests were used to compare diurnal cortisol slopes among three groups: patients who did not have a final diagnosis (uncertain group), patients who knew they had cancer (known malignant group), and patients who knew they had benign disease (known benign group).
  
  
  RESULTS
  Women learned their diagnosis on days 1-6 (mean, day 2.4) after LCBB. Analysis was truncated at day 5, when the data from a sufficient number of patients from each group were available for meaningful analysis: 16 patients from the known malignant group, 37 from the known benign group, and 73 from the uncertain group, which totaled 126 patients. The mean cortisol slope for the women with an uncertain diagnosis (-0.092 ln [microg/dL]/hr; 95% confidence interval [CI]: -0.113 ln [microg/dL]/hr, -0.072 ln [microg/dL]/hr) was significantly flatter (less desirable) than that for the women who learned that they had benign disease (-0.154 ln [microg/dL]/hr; 95% CI: -0.197 ln [microg/dL]/hr, -0.111 ln [microg/dL]/hr; P = .014) but not significantly different from that for the women who learned that they had malignant disease (-0.110 ln [microg/dL]/hr; 95% CI: -0.147 ln [microg/dL]/hr, -0.073 ln [microg/dL]/hr; P = .421).
  
  
  CONCLUSIONS
  Uncertainty about the final diagnosis after LCBB is associated with substantial biochemical distress, which may have adverse effects on immune defense and wound healing. Results indicate the need for more rapid communication of biopsy results.
authors.affiliation: Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02115, USA. elang@bidmc.harvard.edu
authors.forename: Elvira V
authors.initials: EV
authors.lastname: Lang
authors.forename: Kevin S
authors.initials: KS
authors.lastname: Berbaum
authors.forename: Susan K
authors.initials: SK
authors.lastname: Lutgendorf
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000032:analysis; D001707:Biopsy, Needle / Q000009:adverse effects* / Q000523:psychology; D001943:Breast Neoplasms / Q000473:pathology* / Q000523:psychology; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis*; D008875:Middle Aged; D015203:Reproducibility of Results; D012463:Saliva / Q000737:chemistry*; D012680:Sensitivity and Specificity; D013315:Stress, Psychological / Q000175:diagnosis* / Q000209:etiology*; D055815:Young Adult
chemical_list: D015415:Biomarkers; D006854:Hydrocortisone