Accuracy of Office-Based Ultrasound Guided Needle Biopsies Performed by Dedicated Breast Surgeons.

Abstract

Abstract BACKGROUND: Ultrasound guided core biopsies (USCB) are highly accurate, cost effective, and efficient at diagnosing breast disease when compared to the standard excisional biopsy. However, given the national shortage of breast imagers there may be delay in the diagnosis of benign and malignant breast disease. The American Society of Breast Surgeons (ASBS) provides training and certification in USCB for breast surgeons to perform office based procedures. However, few studies have specifically evaluated the accuracy and efficiency of USCB performed by dedicated breast surgeons. We sought to evaluate this question further by looking at the experience of breast surgeons who perform USCB at the Breast Health Center of an academic women's oncology program. We propose that USCB performed by dedicated breast surgeons in the office setting is highly accurate, and offers the patient the highest quality of care.METHODS: Following IRB approval, we identified 100 patients who underwent an USCB in the office of our Breast Health Center by dedicated breast surgeons as part of a diagnostic work-up from 1/2003 to 8/2008. Data collected included patient age, date of presentation, reason for initial consultation, clinical and ultrasound findings, diagnostic imaging, date of biopsy and subsequent surgery, type of biopsy technique used, laterality, number of biopsies performed, and pathology from both core biopsy and final excision.RESULTS: Of the 100 patients in our study, the reason for evaluation was a palpable mass in 85 (85%), and an abnormal mammogram in 13 (13%). The mean age was 44.3 years (range, 16-84). Of these lesions, 89% had a formal radiologic US(RUS) and 56% underwent definitive excision. Eighty patients underwent USCB at the time of initial consultation (80%).Demographics Total populationBiopsy + ExcisionBiopsy Only n=100n=56n=44Presentation † Mass85 (85%)44 (79%)41 (93%)Abnl MMG13 (13%)11 (20%)2 (5%)Other2 (2%)1 (2%)1 (2%)Surgeons impression* Benign41 (52%)9 (20%)32 (94%)Suspicious38 (48%)36 (80%)2 (6%)Radiologists impression* Benign33 (54%)4 (13%)29 (100%)Suspicious28 (46%)28 (87%)0 (0%)*P<0.001, †P<0.05Comparing clinical impression of benign vs. malignant disease derived from office based US (OUS) to RUS, there was 98% agreement (Kappa statistic: 0.96 (SE: 0.14), p<0.0001). There was good agreement on maximal dimensions between OUS and RUS (Spearman correlation of 0.75, p<0.0001). There was 100% agreement (95%CI: 93.6-100%) between pathology from USCB and final pathology at excision (n=56) when classified as benign versus malignant. Excluding 5 patients who underwent neoadjuvant therapy, the median time from USCB to surgery was 24.5 days(range: 3-419 days), for malignant disease it was 23 days (range: 3-76 days) and for benign it was 41 days (range: 14-419 days).CONCLUSION: USCB of breast nodules performed in the office by dedicated breast surgeons is highly accurate at diagnosing both benign and malignant lesions. The majority of patients evaluated underwent an USCB at the time of initial consultation, expediting their diagnosis and definitive treatment and thereby reducing wait time and diagnosis-related anxiety. Our study supports the ASBS process for breast ultrasound and image guided core biopsy education and certification. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6022.