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Author: Charlie Zhang, University of British
Columbia, Faculty of Medicine, Class of 2013
Introduction: Percutaneous image-guided core
needle biopsy (CNB) is currently the standard of care for the
initial diagnosis of suspicious breast lesions. It is less
invasive, less time-consuming and less expensive than surgical
excision, and causes minimal to no scarring. We aim to determine
the negative predictive value (NPV) of sonographically-guided
14-gauge core needle biopsy of breast masses, with detailed
analysis of any false negative cases.
Methods: All patients who have had benign
pathologic findings on sonographically-guided 14-gauge core needle
biopsy of breast lesions from March 2005 through April 2011 at the
Vancouver Breast Center were reviewed. Sonographically-guided CNBs
were performed using a free-hand technique and a high-resolution
ultrasound unit with 10- or 12- MHz linear array transducers. An
automated biopsy gun and 14-gauge needles with a 22mm needle throw
were used. Core biopsies were fixed in formalin and processed
according to standard protocol. 'Strict' true negative cases were
defined as lesions which had benign pathology on core biopsy and
had either benign pathology upon surgical excision or at least 2
years of stable imaging and/or clinical follow-up. False negative
cases were defined as lesions which had benign pathology on core
biopsy but malignant histology upon surgical excision. A benign CNB
lesion subsequently confirmed to be malignant was considered an
"applied true negative" if it was immediately referred to surgery
due to suspicious imaging findings. In other words, the false
negative histology did not result in delayed diagnosis. The
definition of 'applied' NPV was introduced to acknowledge that in
actual practice, the imaging findings are considered along with the
histology to inform follow-up recommendations.
Results: Of the 339 ultrasonographically
visible breast lesions in 319 patients, 117 were confirmed to be
benign via surgical excision, and 220 were stable on = 2 years of
imaging or clinical follow-up (mean follow-up time 33.1 months,
range 24-64 months). The 'strict' NPV of sonographically-guided
14-gauge CNB was determined to be 99.4% (337 of 339 cases), while
the 'applied' NPV was determined to be 100%. There were 2 (0.6%)
false negative US-guided 14-gauge CNB cases. In both cases of
invasive carcinomas, the radiologist determined that there was
discordance between imaging and core biopsy pathology, and
recommended surgical excision despite the benign core biopsy
Conclusion: Sonographically-guided 14-gauge
core needle biopsy provides a high NPV in assessing breast lesions.
Radiologic/pathologic correlations should be performed to avoid
delay in the diagnosis of carcinoma.
February 2013 Issue of IMpact