Ultrasound-guided core-needle biopsy of breast lesions

Luis Apesteguía,Luis Javier Pina

doi:10.1007/s13244-011-0090-7

Abstract

ObjectiveTo review the role of ultrasound-guided core-needle biopsy (CNB) in the management of breast lesions.MethodsReview of the most relevant literature on this topic.ResultsThis technique shows a high sensitivity value of about 97.5% and it offers many advantages over other imaging techniques to guide a biopsy: non-ionising radiation, low cost, full control of the needle in real time, accessibility in difficult locations, multidirectional punctures and excellent comfort for patients and radiologists. All of these advantages have made this technique the most widespread used to perform a biopsy for a suspicious breast lesion. The most important limitation is the failure to perform a biopsy for lesions that are not seen on ultrasound. An adequate radiological–pathological correlation is necessary to minimise the false-negative results.ConclusionUltrasound-guided CNB has proven to be a reliable technique for performing a biopsy for breast lesions that can be clearly seen on ultrasound.

Highlights

Percutaneous imaging-guided breast biopsy is a reliable alternative to surgical biopsy for a histological diagnosis [1,2,3,4,5]
Percutaneous biopsy is less invasive than surgery, can be performed quickly, does not deform the breast, causes minimal scarring, complications are infrequently found, fewer surgeries are needed for patients who undergo percutaneous biopsies and the cost of diagnosis is lower [1,2,3,4,5]
Ultrasound-guided core needle breast biopsy has become the first choice for performing a percutaneous biopsy for most lesions seen on ultrasound [1, 6,7,8,9]

Summary

Results

After the initial results by Parker and co-workers, with a 100% correlation with surgical results for 49 excised masses and no additional cancers in the remaining 132 cases, all the published series have shown excellent results (Table 1) [7,8,9,10, 17, 21,22,23,24,25,26]. – Discordant malignancy: a radiologically benign lesion (BI-RADS 2 or 3) is diagnosed as histologically malignant after core biopsy (B4 or B5). An adequate radiological–pathological correlation should be established, and imaging follow-up should be offered to avoid delayed false-negative results. Some of these lesions can be surgically or percutaneously excised because of patient anxiety, patient decision or physician preference. – Discordant benignity: a radiologically malignant lesion (BI-RADS category 4c or 5) is proved to be benign after core biopsy. In this case, both the imaging and the pathological findings should be reviewed again. Whatever the method of biopsy, the recurrence rate was similar

Introduction

Technical procedure

Conclusion