US-guided core needle biopsy: False-negatives. How to reduce them?

Abstract

Breast cancer is a major cause of suffering and death and is of sigificant concern to many women. Early systematic mammographic creening can detect breast cancers which are more amenable to ffective therapy and generally more favorable for quality of life. pen excision biopsies have increasingly been replaced by preoprative diagnostic techniques such as needle aspiration cytology, nd more commonly, core biopsies. Preoperative core biopsy is ecoming the standard of care in breast cancer. Many institutions ave chosen core biopsy as a preoperative diagnostic tool in breast isease in an attempt to increase diagnostic sensitivity, determine he type and invasive nature of the disease and avoid unnecessary perations [1–4]. Percutaneous image-guided core needle biopsy is erformed under either stereotactic or ultrasound (US) guidance. S guidance offers a number of advantages over stereotactic guidnce. It is performed in real time, and direct needle visualization ith ultrasound allows an accurate assessment of sampling. The rocedure is quicker, causes less patient discomfort and does not nvolve ionizing radiation. The possibility of “missing” or delaying he diagnosis of breast cancer, as a result of a falsely-reassuring enign biopsy, is an outcome that every clinician endeavors to void. In this article, we describe possible causes of sampling errors, alse-negative biopsy specimens and discuss steps that should be aken to diminish potential technical pitfalls, to strive to optimize he technique, to carefully perform radiological–histological correation, and follow-up imaging at appropriate intervals. In the literature, false-negative rates for percutaneous imageuided core needle biopsy have been reported to attain 0–8.9% 3,5,6]. In the case of US-guided 14-gauge core needle biopsies, the alse-negative rates range from 0% to 3.6% (mean, 1.8%) in studies ithout a long-term follow-up and from 1.2% to 3.3% (mean 2%)