The accuracy of ultrasound guided 14–gauge core needle breast biopsy: Correlation with surgical excision or long term follow–up

Abstract

Objective To determine the diagnostic accuracy of ultrasound-guided 14-gauge core-needle breast biopsy (CNB) correlation with surgical excision or long term follow-up. Methods One hundred and fifteen breast lesions which had undergone ultrasound-guided 14-gauge core-needle breast biopsy from May 2003 to Aug 2010 in the Breast Diagnostic Center, King Chulalongkorn Memorial Hospital were included in this study. Clinical history, palpability of the lesion, site of the lesion, the prebiopsy lesion size, ultrasound characteristic, level of suspicion according to the BIRADS classification, number of samples taken and pathologic results of CNB were reviewed and correlated with pathologic results of subsequent open surgery. For benign lesions without surgery, we correlated the result of CNB with stability of the lesion at or more than two-year interval follow-up. The accuracy rate, sensitivity, specificity, false positive rate, false negative rate, positive predictive value and negative predictive value were accessed. The false-negative diagnoses of core needle biopsy were reviewed in detail. Procedural complications were also observed. Results Among 115 lesions, 114 lesions were in female and 1 lesion was in male with their mean age of 50.87 years old (ranging from 27-72), 91 lesions were palpable (79.13%), 24 were non-palpable (20.87%). The prebiopsy size was 3.2 cm in diameter ranging from 0.5-20.0 cm. The pathologic results for the CNB were malignancy in 77.39% (89 lesions), high-risk in 0.87% (1 lesion) and benign in 21.17% (25 lesions). Five patients were negative for malignancy by core needle biopsy but positive for malignancy by surgical procedure. The sensitivity was 94.68%. The specificity was 100%. The false negative rate was 5.3%. The positive predictive value was 100%. The negative predictive value was 80.76%. The accuracy was 95.65%. There was no false positive case. Conclusions Core needle biopsy under ultrasound guidance is a minimally invasive diagnostic tool and gives a high accuracy rate for evaluating breast lesions. This procedure reduces the surgical cases of benign breast disease. However, correlation between imaging and pathology is important for appropriate management of false negative cases.