Ultrasound-guided 14-gauge core-needle biopsy (CNB) is "at least as reliable" as stereotactically guided breast biopsy in the evaluation of high-risk breast lesions, a study suggests [1].
Ultrasound-guided CNB has a number of advantages over surgical biopsy in that it does not result in deformity or excess scarring, and causes less discomfort to patients.
However, a group of radiologists in Austria noted: "Despite a growing body of literature about ultrasound-guided 14-gauge CNB, some clinicians lack confidence about its accuracy."
The group retrospectively reviewed 1352 non-palpable breast lesions in 1311 patients examined by CNB. Of these, 1061 lesions in 1031 patients were surgically excised following CNB, and the remaining 291 lesions in 280 patients were followed-up clinically and radiologically for more than two years.
Of the lesions that were subsequently excised, 671 were classified as malignant on CNB, 86 as high-risk, and 304 as benign.
All 671 malignancies identified on CNB were confirmed by histology following surgical excision. Twenty-seven of the high-risk lesions were upgraded to malignancy at surgical excision, an underestimation rate of 31.4 per cent. Of the 304 lesions classified as benign on CNB, nine were shown on surgical excision to be high-risk lesions, and 11 were demonstrated to be cancer on surgical excision.
All 291 lesions which were not later excised appeared benign and stable over follow-up.
The researchers calculated agreement between US-guided 14-gauge CNB results and subsequent findings of 95.8 per cent and a sensitivity rate of 98.5 per cent, and a false-negative rate of 1.6 per cent.
They reasoned that the data "provide strong validation that US-guided 14-gauge CNB provides breast diagnosis with a high degree of accuracy."
The group concluded: "Data from this investigation… may help to convince health authorities and breast surgeons to accept this diagnostic strategy as an alternative to surgical excision."
[1] US-guided 14-gauge core-needle breast biopsy: Results of a validation study in 1352 cases
Radiol 2008; 248: 406-413
