Can the radiologist accurately predict the adequacy of sampling when performing ultrasound-guided core biopsy of BI-RADS category 4 and 5 lesions detected on screening mammography?

Abstract

To investigate in mammography screening the correlation between the confidence level of the radiologist, in sampling BI-RADS assessment category 4 and 5 lesions using a single ultrasound-guided 14-gauge needle core biopsy, and the final histological diagnosis. In a prospective study, 389 consecutive ultrasound-guided 14-gauge needle core biopsies were performed on 131 BI-RADS assessment category 4 and 5 breast lesions in 126 women. On average, 3 passes were made through each lesion; for each pass, the radiologist rated confidence in adequacy of sampling at <50%, 50% to 90% or >90%. This was compared with the final histological diagnosis. The radiologist was >90% confident in 293 biopsies; diagnostic results were confirmed at histology in 283 (97%). In 70 biopsies the radiologist was 50% to 90% confident; diagnostic results were confirmed in 60 (86%). Of 26 samples where confidence was <50%, 13 were diagnostic (50%) (p<0.0001). If, at the time of ultrasound-guided needle core biopsy of BI-RADS assessment category 4 and 5 breast lesions, the radiologist is >90% confident that the lesion has been adequately sampled, a single pass is usually sufficient for diagnosis.