Ultrasound-guided core-needle breast biopsy could present alternative to surgery

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An ultrasonography (US)-guided, 14-gauge, core-needle breast biopsy (CNB) is a reliable alternative to stereotactic biopsy of nonpalpable, high-risk breast lesions, according to a study in the August issue of Radiology.

Gerd Schueller, MD, from the department of radiology at the Medical University of Vienna in Vienna, Austria, and colleagues set out to retrospectively determine the false-negative rate and the underestimation rate of US-guided, 14-gauge CNB in nonpalpable lesions, with validation at surgical excision histologic examination, as well as with stability during clinical and imaging follow-up.

In 1,061 cases, patients underwent surgical excision of lesions visible at US subsequent to US-guided, 14-gauge CNB, the authors wrote. Follow-up of another 291 benign lesions at US-guided, 14-gauge CNB histologic exam showed stability during clinical and imaging follow-up for at least two years. The researchers reviewed and compared US and histologic findings for agreement.

The investigators defined false-negative findings as pathologically proved cancer for which biopsy results were benign. The false-negative rate was defined as the proportion of all breast cancers with a diagnosis of benign disease at US-guided, 14-gauge CNB. The underestimation rate was defined as an upgrade of a high-risk lesion at US-guided, 14-gauge CNB to malignancy at surgery, according to the researchers.

Schueller and colleagues found that US –guided, 14-gauge CNB yielded 671 (63.2 percent) malignant, 86 (8.1 percent) high-risk and 304 (28.7 percent) benign lesions. Each of the 291 benign lesions without surgery remained stable during follow-up.

The agreement of US-guided, 14-gauge CNB results, surgical excision findings, and follow-up results was 95.8 percent, the authors wrote. False-negative findings were encountered in 11 (0.8 percent) of 1352 cases, and the false-negative rate was 1.6 percent (11 of 671 malignancies).

The researchers found that all false-negative findings were prospectively identified owing to discordance between imaging results and US-guided, 14-gauge CNB histologic findings; and the underestimation rate was 31.4 percent.

Based on their results, the authors wrote that their data “support “prior recommendations from several percutaneous core-needle biopsy studies, including studies with US-guided, 14-gauge CNB, that surgical excision is necessary in all cases in which the histologic findings do not explain the imaging features.”

The researchers said that their data also “support the hypothesis that US-guided, 14-gauge CNB is at least as reliable as and as feasible as stereotactically guided breast biopsy for the characterization of high-risk lesions.”