Ultrasonographically guided 18-gauge automated core needle breast biopsy with post-fire needle position verification (PNPV)

Abstract

Percutaneous imaging-guided core needle biopsy (CNB) is being used increasingly as an alternative to surgical biopsy for the diagnosis of breast lesions that are suspicious or highly suggestive of malignancy. The purpose of this study was to evaluate ultrasonographically (US) guided 18-gauge automated CNB with post-fire needle position verification (PNPV) in the assessment of US visible breast lesions. Biopsy of 235 US visible breast lesions was performed using US-guided 18-gauge core needles (18-GCN). After firing the biopsy needle, an image was obtained in the orthogonal plane to confirm the precise post-fire position of the needle track before removing the needle. Needle core diagnoses were compared with surgical diagnoses in 235 lesions subsequently surgically excised. The median size of the lesions was 14 mm (range, 5-60 mm). Agreement between needle core and surgical diagnoses in the 235 lesions was 92% including 192 cancers, 28 benign lesions, and 3 high-risk lesions. In the remaining 12 discordant lesions, 4 were high-risk lesions and 8 were benign lesions. In all 8 benign lesions, imaging-histological discordance was present. The sensitivity of US guided 18-GCNB for breast cancer was 96% (199 of 207). In 71% (167/235) of the cases only one core with PNPV was made. No complications occurred. US-guided 18-GCNB for sonographically-demonstrated discrete mass lesions with PNPV is an accurate core needle biopsy technique of breast cancer. During the course of tissue sampling, evaluating the post-fire needle tip position by obtaining an orthogonal view with ultrasonographic guidance is the key to predicting the yield regardless of the size of the needle or the number of core samples.