The Accuracy of Ultrasound, Stereotactic, and Clinical Core Biopsies in the Diagnosis of Breast Cancer, With an Analysis of False-Negative Cases

Department of Surgery, St. Vincent's University Hospital, Dublin, Ireland.
Annals of Surgery (Impact Factor: 8.33). 12/2005; 242(5):701-7. DOI: 10.1007/BF03170151
Source: PubMed


Preoperative core biopsy in breast cancer is becoming the standard of care. The aim of this study was to analyze the various methods of core biopsy with respect to diagnostic accuracy and to examine the management and outcome of those patients with false-negative biopsies.
All patients undergoing core biopsy for breast abnormalities over a 5-year period (1999-2003) were reviewed. The accuracy rates for each method of core biopsy, the histologic agreement between the core pathology and subsequent excision pathology, and the length of follow-up for cases of benign disease were studied. Patients whose biopsies were benign but who were subsequently diagnosed with cancer underwent detailed review.
There were 2427 core biopsies performed over the 5-year period, resulting in a final diagnosis of cancer in 1384 patients, benign disease in 954 patients, and atypical disease in 89 patients. Biopsy type consisted of 1279 ultrasound-guided cores, 739 clinically guided cores, and 409 stereotactic-guided cores. The overall false-negative rate was 6.1%, with specific rates for ultrasound-, clinical-, and stereotactic-guided cores of 1.7%, 13%, and 8.9%, respectively. False-negative biopsies occurred in 85 patients, and in 8 of these patients the diagnosis was delayed by greater than 2 months. In all other false-negative cases, "triple assessment" review allowed prompt recognition of discordant biopsy results and further evaluation.
Ultrasound guidance should be used to perform core biopsies in evaluating all breast abnormalities visible on ultrasound. Adherence to principles of triple assessment following biopsy allows for early recognition of the majority of false-negative cases.

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Available from: Niall O'Higgins, Aug 14, 2014
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    • "Still, this false-negative rate specific to discordant CNBs is substantially higher than the false-negative rates reported in the literature for all VAB procedures, consistently found to be under 2% [12] [19] [26] [27]. It is more comparable with the rates reported for CNB, which can approach 10% [8] [12] [27] [28]. Given that a benign-discordant VAB carried a risk of malignancy of 6.3% in our series, surgical EXB is warranted for these lesions. "
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    ABSTRACT: Vacuum-assisted core-needle biopsy (VAB) is increasingly used to perform breast biopsies instead of automated-gun core-needle biopsy (CNB). The significance of discordance between radiologic and pathologic findings has not been well established in the era of VAB predominance. This retrospective study was conducted to determine the rate of malignancy after surgical excisional biopsy (EXB) of these lesions at our two institutions. We reviewed medical records from January 2008-June 2013 to identify female patients who underwent EXB for a Breast Imaging-Reporting and Data System (BI-RADS) 4 or 5 lesions found to be benign and discordant on CNB. Clinicopathologic data were gathered, and analysis was performed using descriptive statistics. A total of 8081 core biopsies were performed in the study timeframe. Six of 81 (7.4%) patients who had an EXB for a benign discordant breast lesion were found to have malignant pathology (two invasive, four in situ). Four of 63 (6.3%) lesions originally biopsied by VAB were upgraded, compared with 2 of 17 (11.8%) originally biopsied by CNB. There were no statistically significant differences in the rates of upgrade to malignancy when data were stratified by BI-RADS score or method of biopsy. The overall rate of malignancy after EXB of benign discordant lesions was 7.4%. Despite the widespread adoption of VAB, EXB is still warranted for clarification of discordant radiologic-pathologic findings. Copyright © 2014 Elsevier Inc. All rights reserved.
    Full-text · Article · Nov 2014 · Journal of Surgical Research
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    • "A false-negative diagnosis may delay the treatment of breast cancer. The analysis by Dillon et al of the management and outcome of patients with false-negative cores showed that reviewing the radiological, clinical, and pathological results after the biopsy reduces the delay in the cancer diagnosis to less than one month[21]. US and clinical findings were found to raise the level of suspicion in most of these cases, and FNAB can help the clinician recognize suspicious lesions. "
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    ABSTRACT: The aims of this study were to determine the accuracy of concurrent core needle biopsy (CNB) and fine needle aspiration biopsy (FNAB) for breast lesions and to estimate the false-negative rate using the two methods combined. Over a seven-year period, 2053 patients with sonographically detectable breast lesions underwent concurrent ultrasound-guided CNB and FNAB. The sonographic and histopathological findings were classified into four categories: benign, indeterminate, suspicious, and malignant. The histopathological findings were compared with the definitive excision pathology results. Patients with benign core biopsies underwent a detailed review to determine the false-negative rate. The correlations between the ultrasonography, FNAB, and CNB were determined. Eight hundred eighty patients were diagnosed with malignant disease, and of these, 23 (2.5%) diagnoses were found to be false-negative after core biopsy. After an intensive review of discordant FNAB results, the final false-negative rate was reduced to 1.1% (p-value = 0.025). The kappa coefficients for correlations between methods were 0.304 (p-value < 0.0001) for ultrasound and FNAB, 0.254 (p-value < 0.0001) for ultrasound and CNB, and 0.726 (p-value < 0.0001) for FNAB and CNB. Concurrent CNB and FNAB under ultrasound guidance can provide accurate preoperative diagnosis of breast lesions and provide important information for appropriate treatment. Identification of discordant results using careful radiological-histopathological correlation can reduce the false-negative rate.
    Full-text · Article · Jul 2010 · BMC Cancer
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    • "The tumors ranged in size from 9 to 13 mm, and two of the three malignancies were invasive lobular carcinomas. Dillon and colleagues [6] reviewed 2427 coreneedle biopsies performed over a 5-year period. The authors reviewed 1279 ultrasound-guided core biopsies, 739 clinically guided core biopsies, and 409 stereotactic core biopsies. "
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    ABSTRACT: Currently, in the United States, most initial biopsy procedures are performed with percutaneous techniques [28]. Most biopsies of masses are performed with sonographic guidance. Ultrasound-guided biopsies may be performed with vacuum-assisted probes, core needles, or fine needles. Percutaneous ultrasound-guided biopsies can provide a definitive histopathologic diagnosis and allow optimal surgical planning, which often results in a single surgical procedure with adequate margins [29]. Ultrasound-guided biopsy of benign conditions allows the avoidance of open biopsies for benign processes. In addition, ultrasound-guided biopsies are less invasive, less deforming, less expensive, and faster than surgical biopsies. Physicians who perform ultrasound-guided breast biopsies must use appropriate techniques and be willing to assume responsibility for establishing imaging-pathologic concordance and render appropriate referral and follow-up recommendations [24]. Ongoing developments in ultrasound equipment and tissue-acquisition devices will allow more breast biopsies to be performed more accurately in the future.
    Full-text · Article · Oct 2006 · Ultrasound Clinics
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