Is US-guided 14-gauge Core Needle Biopsy Valid for Papillary Neoplasm of the Breast? / 한국유방암학회지

PURPOSE: We wanted to determine the underestimation rate of ultrasound (US)-guided 14-gauge core needle biopsy for papillary neoplasms that were treated with subsequent surgical excision or vacuum-assisted biopsy (VAB) and we also wanted to evaluate the sonographic findings of papillary neoplasms. METHODS: A retrospective review of the US-guided core needle biopsies of 984 consecutive lesions from January 2004 to April 2006 revealed 29 (3%) papillary neoplasms. Twenty five lesions were further excised by surgery (n=16) or VAB (n=9). The remaining 4 lesions were not further excised and they were excluded from this study. We evaluated the concordance between results of core needle biopsy and the final pathologic results. We reevaluate the sonographic findings of the papillary neoplasms included in our study. RESULTS: The pathologic results of core needle biopsy were benign in 21 and atypical in four. Of the 21 benign papillomas, none were revealed as carcinoma after further excision. Just one lesion showed focal atypical ductal hyperplasia (ADH) after VAB. Three intraductal papillomas with ADH underwent surgical excision (n=3) or VAB (n=1), and they were proved to be the same pathologic entities with (n=1) or without (n=3) lobular neoplasia. The sonographic findings were as follows: four intraductal masses, four intracystic masses, four solid masses with peripheral anechoic rims, five extraductal masses adjacent to dilated ducts, six pure solid masses, and two mixed masses. CONCLUSION: US-guide 14-gauge core needle biopsy for papillary neoplasm showed no underestimation after surgical excision or VAB in our study, and the procedure proved to be reliable for the assessment of papillary neoplasm if the imaging and pathologic findings were concordant. Papillary neoplasms showed variable sonographic findings.

Usefulness of Ultrasound Guided Core Needle Biopsy of Breast Lesions with Automated Gun / 한국유방암학회지

It is necessary to confirm disease pathologically even though there are several methods of diagnosis for breast abnormality. Ultrasound guided core needle biopsy (UGCNB) of breast lesions with automated gun is widely accepted as a simple and accurate procedure for avoiding open biopsy. From January 1996 to February 1998, 121 breast lesions of 117 women detected with mammogram, ultrasound, physical examination or any combination were selected. UGCNB was performed in all 121 cases with 7.5 MHz transducer and Manan Pro-mag 2.2 automated biopsy gun (2.2 cm excursion). After local anesthesia, 5-6 cores were obtained through 2mm skin incision site. Lesions categorized as probably benign to highly suspicious were included as indications for core biopsy. 67.5% of the 117 patients were in age thirties and forties. The results of the biopsy were benign in 65 lesions and malignant in 56. 15 patients showing benign results which were contrary to clinical findings and pathologic results, underwent open biopsy. Four patients who had previously been diagnosed as being benign, were found to be malignant (false-negative 3.3%). Primary results of four cases of false negative were intraductal papilloma, severe inflammatory change, atypical ductal hyperplasia, and insufficient sampling, respectively. In case of insufficient sampling resulted from small gauge needle (18G), correct diagnosis was possible in all lesions with large needle (14G). Also excisional biopsy was required in women having intraductal papilloma, severe inflammation and atypical ductal hyperplasia which were difficult to differenciate from malignancy. The UGCNB is excellent biopsy method for multiple breast lesions. The method has demonstrated a 96.7% sensitivity specificity 100%, and positive predictive value (PPV) of 46.3%. We also conclude that UGCNB is proved To be an useful alternative to surgical biopsy on simpler procedure with no adverse cosmetic results.