Image-guided core biopsy in patients with breast disease

Abstract

Ultrasonographically-guided core biopsy has been used as an adjunct to triple assessment when fine-needle aspiration cytology was inadequate or equivocal, if the overall assessment of the patient was uncertain, or if it was deemed the preferred diagnostic option. Some 143 of 2603 patients had a guided core biopsy, 125 to establish the diagnosis and 18 to obtain histology in cytologically proven malignancy. A diagnosis of malignancy was established in 43 of the 125 patients who had a diagnostic core biopsy. Some 45 patients with benign disease were either discharged or returned to follow-up on the basis of the core biopsy. The remaining 37 patients required surgical biopsy, of whom 13 had malignant and 24 benign disease. The overall positive predictive value for malignancy was 98 per cent. Experience with ultrasonographically-guided core biopsy shows that it can reduce the need for surgical biopsy in both benign and malignant conditions of the breast.

The utility of ultrasonographically guided large‐core needle biopsy: results from 500 consecutive breast biopsies.

“…Our results are similar to those of Parker et al 13 and Liberman et al 12 and compare favorably with those of Chare et al 14 Of the malignant lesions in our study, discordance between the histopathologic results after ultrasonographically guided LCNB and the results after surgical excision was rarely seen. Only 1 of 5 lesions with a diagnosis of DCIS by ultrasonographically guided LCNB was upgraded to IDC after surgical excision.…”

“…Of the remaining 151 lesions, 94 were benign, 56 were malignant, and 1 was ADH. Chare et al 14 described a series of 125 lesions sampled by 16-gauge ultrasonographically guided LCNB. A definite decision regarding treatment could be made in only 88 lesions (70%) in this series.…”

“…12 Ultrasonographically guided 14-gauge core breast biopsy was first described in 1993 by Parker et al 13 Since then there have been few large series describing ultrasonographically guided 14-gauge LCNB. 12,14,15 Most radiology departments maintain ultrasonographic equipment, so initial implementation of this technique should not require significant additional expense. However, as the demand for ultrasonographically guided biopsy increases, equipment specifically dedicated to breast imaging may be required, although the cost remains significantly less than the cost of a stereotactic prone table.…”

Der falsch-negative Befund der ultraschallgestutzten Stanzbiopsie von Herdbefunden der Brust: Liefert die immunhistochemische Analyse mit dem Epithelial-Membrane-Antigen einen diagnostischen Zugewinn?

“…Bei der Bewertung falsch‐negativer Befunde perkutaner interventioneller Methoden (Feinnadelbiopsie, CNB und Vakuumbiopsie) ist zu unterscheiden zwischen der wahren falsch‐negativ Rate und der systemimmanenten Fehlerrate. Für die CNB wird diese mit 2 % – 4 % (Median 3,3 %) angegeben (5, 6, 18). Die kürzlich erschienene Arbeit von Reynolds zeigt, daß bestimmte pathologisch benigne Entitäten eine erhöhte Inzidenz an Karzinomen aufweisen: atypisch duktale Hyperplasie (ADH), atypisch lobuläre Hyperplasien, lobuläres Carcinoma in Situ (LCIS), hoch‐suspekte papilläre Läsionen, sklerosierende Papillome, radiäre Narben und Phylloid‐Tumore (21).…”

“…Seit der Einführung dieser Methode durch Parker 1993 bestätigten Studien die Reliabilität, Validität und Kosteneffektivität dieser Methode (19). Dabei konnte gezeigt werden, daß die CNB eine Spezifität von 100 % hat, die Sensitivität jedoch zwischen 80 % und 100 % variiert (5, 9, 18, 23). Für die stereotaktische Stanzbiopsie liegt die falsch‐negativ Rate bei 0,3 % – 8,2 % (Median: 4,2 %).…”