US-guided core-needle breast biopsy offers alternative to surgery

Ultrasound-guided 14-gauge core-needle biopsy has been shown to provide accurate tissue sampling, produce minimal scarring on subsequent mammograms, and cause less patient discomfort than surgical biopsy. It's also quicker and less expensive.

Yet some doctors aren't confident of the procedure's accuracy. Using ultrasound-guided 14-gauge core-needle biopsy as a first-choice option for assessing breast lesions is complicated by the potential of histologic underestimation of ductal carcinoma in situ (DCIS) lesions and invasive malignancy. Researchers at the Medical University of Vienna in Austria and Memorial Sloan-Kettering Cancer Center in New York City studied the technique's false-negative and underestimation rates and reported their findings in this month's Radiology (August 2008, Vol. 248:2, pp. 406-413).

Dr. Gerd Schueller and colleagues reviewed 1,352 cases of ultrasonographically visible, nonpalpable breast lesions. Histologic exam results for each lesion were compared with imaging results. In 1,061 of these cases, patients had surgical excision of the lesions subsequent to an ultrasound-guided 14-gauge core-needle biopsy (Bard Magnum biopsy instrument, C.R. Bard, Murray Hill, NJ).

Of the 1,352 lesions:

  • 181 (13.4%) were classified as BI-RADS 3
  • 684 (50.6%) were classified as BI-RADS 4
  • 487 (36%) were classified as BI-RADS 5

Histologic exams at ultrasound-guided 14-gauge core-needle biopsy found:

  • 619 (58.3%) invasive carcinomas
  • 52 (4.9%) ductal carcinoma in situ lesions
  • 86 (8.1%) high-risk lesions
  • 304 (28.7%) benign lesions

Schueller's team discovered that ultrasound-guided 14-gauge core-needle biopsy results showed an agreement with surgical excision and follow-up of 95.8%.

Correlation of US-guided 14-gauge core-needle biopsy (CNB) results and surgical excision histologic findings
Surgical excision CNB
Benign lesion High-risk lesion DCIS lesion Invasive cancer Total
Benign lesion 284 (26.8)* 2 (0.2)* 0 (0) 0 (0) 286 (27.0)
High-risk lesion 9 (0.8)* 57 (5.4)* 0 (0) 0 (0) 66 (6.2)
DCIS lesion 3 (0.3) 11 (1.0) 33 (3.1)* 20 (1.9)* 67 (6.3)
Invasive cancer 8 (0.8) 16 (1.5) 19 (1.8) 599 (56.5)* 642 (60.5)
Total 304 (28.7) 86 (8.1) 52 (4.9) 619 (58.3) 1,061 (100)
Note: Data are numbers of lesions. Numbers in parentheses are percentages, which were rounded.
*Surgical findings considered to be in agreement with CNB results.
Schueller G, Jaromi S, Ponhold L, et al. US-guided 14-gauge core-needle breast biopsy. Radiology. 2008;248(2):406-413. Table 1. Courtesy of the Radiological Society of North America.

There were 11 false-negative results from the biopsies (0.8% of 1,352 cases and 1.6% of 671 malignancies). Each of the false negatives was identified when the imaging results and histologic findings didn't agree. The team found this rate to be well within the scope of false-negative rates of 0% to 9% in prior studies of 14-gauge core-needle biopsy. The data showed an underestimation rate of 31.4%, comparable to the rate of 33% found in other studies.

Schueller and colleagues wrote that radiologists who perform this procedure must be aware of technical challenges that can result in inaccurate sampling, including targeting errors secondary to poor lesion or needle visualization, lesion mobility, deep lesions, central lesions in a large breast, dense fibrotic material that resists the needle, and patient movement.

Despite these challenges, the group concluded that ultrasound-guided 14-gauge core-needle biopsy provides an accurate alternative to surgical excision for evaluating nonpalpable breast lesions.

By Kate Madden Yee
AuntMinnie.com staff writer
August 7, 2008

Related Reading

Ultrasound continues to make inroads in breast imaging, February 6, 2007

Automated breast US proves to be sensitive screening tool in dense breasts, November 29, 2006

Streaming US, elastography US give clearer picture of breast lesions, November 16, 2006

Breast surgeon expresses reservations about screening US, May 13, 2006

Breast ultrasound experts share pearls and pitfalls, October 2, 2003

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