Journal of Ultrasound in Medicine, Vol 20, Issue 9 967-972, Copyright © 2001 by American Institute of Ultrasound in Medicine
Fourteen-gauge ultrasonographically guided large-core needle biopsy of breast masses
J. M. Schoonjans and R. F. Brem
Department of Radiology, George Washington University Medical Center, Washington, DC 20037, USA.
OBJECTIVE: Large-core needle biopsy of the breast can be performed with
stereotactic or ultrasonographic guidance. However, ultrasonographically
guided large-core needle biopsy has notable advantages, including the
absence of ionizing radiation, increased patient comfort, and greater
cost-effectiveness. The purpose of this study was to evaluate the accuracy
of ultrasonographically guided large-core needle biopsy for the diagnosis
of breast cancer in palpable and nonpalpable breast masses. METHODS: The
study was a retrospective review of consecutive ultrasonographically guided
large-core needle biopsies for indeterminate breast masses. A total 424
ultrasonographically guided core biopsies were performed in 367 patients
with 1 or more breast masses. Ultrasonographically guided core biopsy was
performed with a 14-gauge spring-loaded needle and a freehand technique.
Correlation of ultrasonographically guided core biopsy pathologic findings
with subsequent surgical pathologic findings or long-term imaging follow-up
was performed. RESULTS: Of 424 indeterminate breast lesions for which
histopathologic findings were obtained by ultrasonographically guided core
biopsy, 234 cancers were diagnosed. Twenty-eight additional lesions had
either questionable but not definitively malignant pathologic features (n =
11) or radiologic-pathologic discordance (n = 17) and were surgically
excised. Of these, 8 additional cancers were diagnosed. Patients or
surgeons chose excision of 41 additional lesions that were benign on
ultrasonographically guided core biopsy No cancer was found in these
surgical specimens. One additional cancer was diagnosed at a 6-month
imaging follow-up because of interval growth. On the basis of surgical and
long-term imaging follow-up, the sensitivity of ultrasonographically guided
core biopsy for the diagnosis of breast carcinoma was 99.2% (95% confidence
interval, 95.6%-99.9%) in 173 palpable breast masses and 93.2% (95%
confidence interval, 87.1%-97%) in 251 nonpalpable masses. In cancers
diagnosed on the basis of immediate surgical excision as a result of
ultrasonographically guided core biopsy that showed either questionable
pathologic features or radiologic-pathologic discordance, the sensitivity
of ultrasonographically guided core biopsy for the diagnosis of breast
cancer was 99.2%. CONCLUSIONS: Ultrasonographically guided large-core
needle biopsy is a sensitive percutaneous biopsy method for the diagnosis
of breast cancer in palpable and nonpalpable breast masses.
