European Radiology

, Volume 20, Issue 4, pp 782–789

Analysis of false-negative results after US-guided 14-gauge core needle breast biopsy

  • Ji Hyun Youk
  • Eun-Kyung Kim
  • Min Jung Kim
  • Jin Young Kwak
  • Eun Ju Son
Breast
  • 208 Downloads

Abstract

Objectives

To determine the false-negative rate and to evaluate the clinical, radiologic or histologic features of false-negative results at ultrasound (US)-guided 14-gauge core needle biopsy (CNB).

Methods

A total of 3,724 masses from 3,308 women who had undergone US-guided 14-gauge CNB and who had a rebiopsy or at least 2 years’ follow-up were included. The histology of CNB was correlated with the rebiopsy or long-term imaging follow-up. In cases of missed cancer, the time interval between CNB and rebiopsy, the reasons for rebiopsy, and the procedural or lesion characteristics were analysed.

Results

Of 1,706 benign CNBs, 50 additional malignancies were found at excision (false-negative rate, 2.5% of 1,982 with a final diagnosis of malignancy). Of 50 false negatives, 41 were found immediately of which 28 had rebiopsy because of imaging-histological discordance. Regarding the frequency of malignancy according to the reasons for rebiopsy, suspicious imaging finding (24%) showed significantly higher frequency than suspicious clinical findings or request (1%). Regarding the characteristics except invasiveness, no significant differences in false-negative rates were found.

Conclusions

Most false negatives were found immediately and imaging-histological discordance was the most important clue. Careful correlation of clinical, radiological and histological results as well as appropriate follow-up is essential.

Keywords

Breast Neoplasm Diagnosis Ultrasound Biopsy Needle 

References

  1. 1.
    Dillon MF, Hill AD, Quinn CM, O’Doherty A, McDermott EW, O’Higgins N (2005) The accuracy of ultrasound, stereotactic, and clinical core biopsies in the diagnosis of breast cancer, with an analysis of false-negative cases. Ann Surg 242:701–707CrossRefPubMedGoogle Scholar
  2. 2.
    Bassett LW, Mahoney MC, Apple SK (2007) Interventional breast imaging: current procedures and assessing for concordance with pathology. Radiol Clin North Am 45:881–894CrossRefPubMedGoogle Scholar
  3. 3.
    Verkooijen HM, Peeters PH, Buskens E et al (2000) Diagnostic accuracy of large-core needle biopsy for nonpalpable breast disease: a meta-analysis. Br J Cancer 82:1017–1021CrossRefPubMedGoogle Scholar
  4. 4.
    Liberman L, Dershaw DD, Glassman JR et al (1997) Analysis of cancers not diagnosed at stereotactic core breast biopsy. Radiology 203:151–157PubMedGoogle Scholar
  5. 5.
    Lee CH, Philpotts LE, Horvath LJ, Tocino I (1999) Follow-up of breast lesions diagnosed as benign with stereotactic core-needle biopsy: frequency of mammographic change and false-negative rate. Radiology 212:189–194PubMedGoogle Scholar
  6. 6.
    Parker SH, Burbank F, Jackman RJ et al (1994) Percutaneous large-core breast biopsy: a multi-institutional study. Radiology 193:359–364PubMedGoogle Scholar
  7. 7.
    Meyer JE, Christian RL, Lester SC et al (1996) Evaluation of nonpalpable solid breast masses with stereotaxic large-needle core biopsy using a dedicated unit. AJR Am J Roentgenol 167:179–182PubMedGoogle Scholar
  8. 8.
    Fajardo LL, Pisano ED, Caudry DJ et al (2004) Stereotactic and sonographic large-core biopsy of nonpalpable breast lesions: results of the Radiologic Diagnostic Oncology Group V study. Acad Radiol 11:293–308CrossRefPubMedGoogle Scholar
  9. 9.
    Youk JH, Kim EK, Kim MJ, Oh KK (2008) Sonographically guided 14-gauge core needle biopsy of breast masses: a review of 2,420 cases with long-term follow-up. AJR Am J Roentgenol 190:202–207CrossRefPubMedGoogle Scholar
  10. 10.
    Crystal P, Koretz M, Shcharynsky S, Makarov V, Strano S (2005) Accuracy of sonographically guided 14-gauge core-needle biopsy: results of 715 consecutive breast biopsies with at least two-year follow-up of benign lesions. J Clin Ultrasound 33:47–52CrossRefPubMedGoogle Scholar
  11. 11.
    Schueller G, Jaromi S, Ponhold L et al (2008) US-guided 14-gauge core-needle breast biopsy: results of a validation study in 1352 cases. Radiology 248:406–413CrossRefPubMedGoogle Scholar
  12. 12.
    Schoonjans JM, Brem RF (2001) Fourteen-gauge ultrasonographically guided large-core needle biopsy of breast masses. J Ultrasound Med 20:967–972PubMedGoogle Scholar
  13. 13.
    Liberman L, Feng TL, Dershaw DD, Morris EA, Abramson AF (1998) US-guided core breast biopsy: use and cost-effectiveness. Radiology 208:717–723PubMedGoogle Scholar
  14. 14.
    Schueller G, Schueller-Weidekamm C, Helbich TH (2008) Accuracy of ultrasound-guided, large-core needle breast biopsy. Eur Radiol 18:1761–1773CrossRefPubMedGoogle Scholar
  15. 15.
    Shah VI, Raju U, Chitale D, Deshpande V, Gregory N, Strand V (2003) False-negative core needle biopsies of the breast: an analysis of clinical, radiologic, and pathologic findings in 27 consecutive cases of missed breast cancer. Cancer 97:1824–1831CrossRefPubMedGoogle Scholar
  16. 16.
    Jackman RJ, Nowels KW, Rodriguez-Soto J, Marzoni FA Jr, Finkelstein SI, Shepard MJ (1999) Stereotactic, automated, large-core needle biopsy of nonpalpable breast lesions: false-negative and histologic underestimation rates after long-term follow-up. Radiology 210:799–805PubMedGoogle Scholar
  17. 17.
    Liberman L, Drotman M, Morris EA et al (2000) Imaging-histologic discordance at percutaneous breast biopsy. Cancer 89:2538–2546CrossRefPubMedGoogle Scholar
  18. 18.
    Berg WA (2004) Image-guided breast biopsy and management of high-risk lesions. Radiol Clin North Am 42:935–946CrossRefPubMedGoogle Scholar
  19. 19.
    Burbank F, Parker SH (1998) Methods for analysis of one-step breast biopsy programs. Breast J 4:307–319CrossRefGoogle Scholar
  20. 20.
    Sauer G, Deissler H, Strunz K et al (2005) Ultrasound-guided large-core needle biopsies of breast lesions: analysis of 962 cases to determine the number of samples for reliable tumour classification. Br J Cancer 92:231–235PubMedGoogle Scholar
  21. 21.
    Parker SH, Jobe WE, Dennis MA et al (1993) US-guided automated large-core breast biopsy. Radiology 187:507–511PubMedGoogle Scholar
  22. 22.
    Smith DN, Rosenfield Darling ML, Meyer JE et al (2001) The utility of ultrasonographically guided large-core needle biopsy: results from 500 consecutive breast biopsies. J Ultrasound Med 20:43–49PubMedGoogle Scholar
  23. 23.
    Mainiero MB, Koelliker SL, Lazarus E, Schepps B, Lee CH (2002) Ultrasound-guided large-core needle biopsy of the breast: frequency and results of repeat biopsy. J Womens Imaging 4:52–57CrossRefGoogle Scholar
  24. 24.
    Cho N, Moon WK, Cha JH et al (2005) Sonographically guided core biopsy of the breast: comparison of 14-gauge automated gun and 11-gauge directional vacuum-assisted biopsy methods. Korean J Radiol 6:102–109CrossRefPubMedGoogle Scholar
  25. 25.
    Philpotts LE, Hooley RJ, Lee CH (2003) Comparison of automated versus vacuum-assisted biopsy methods for sonographically guided core biopsy of the breast. AJR Am J Roentgenol 180:347–351PubMedGoogle Scholar
  26. 26.
    Bolivar AV, Alonso-Bartolome P, Garcia EO, Ayensa FG (2005) Ultrasound-guided core needle biopsy of non-palpable breast lesions: a prospective analysis in 204 cases. Acta Radiol 46:690–695CrossRefPubMedGoogle Scholar
  27. 27.
    Muttarak M, Lerttumnongtum P, Chaiwun B, Peh WC (2008) Spectrum of papillary lesions of the breast: clinical, imaging, and pathologic correlation. AJR Am J Roentgenol 191:700–707CrossRefPubMedGoogle Scholar
  28. 28.
    Tseng HS, Chen YL, Chen ST et al (2009) The management of papillary lesion of the breast by core needle biopsy. Eur J Surg Oncol 35:21–24PubMedGoogle Scholar
  29. 29.
    Skandarajah AR, Field L, Yuen Larn Mou A et al (2008) Benign papilloma on core biopsy requires surgical excision. Ann Surg Oncol 15:2272–2277CrossRefPubMedGoogle Scholar
  30. 30.
    Lam WW, Chu WC, Tang AP, Tse G, Ma TK (2006) Role of radiologic features in the management of papillary lesions of the breast. AJR Am J Roentgenol 186:1322–1327CrossRefPubMedGoogle Scholar
  31. 31.
    Mercado CL, Hamele-Bena D, Oken SM, Singer CI, Cangiarella J (2006) Papillary lesions of the breast at percutaneous core-needle biopsy. Radiology 238:801–808CrossRefPubMedGoogle Scholar
  32. 32.
    Liberman L (2002) Percutaneous image-guided core breast biopsy. Radiol Clin North Am 40:483–500CrossRefPubMedGoogle Scholar
  33. 33.
    Youk JH, Kim EK, Kim MJ, Lee JY, Oh KK (2007) Missed breast cancers at US-guided core needle biopsy: how to reduce them. Radiographics 27:79–94CrossRefPubMedGoogle Scholar
  34. 34.
    de Lucena CE, Dos Santos Junior JL, de Lima Resende CA, do Amaral VF, de Almeida Barra A, Reis JH (2007) Ultrasound-guided core needle biopsy of breast masses: How many cores are necessary to diagnose cancer? J Clin Ultrasound 35:363–366CrossRefPubMedGoogle Scholar
  35. 35.
    Moon WK, Myung JS, Lee YJ, Park IA, Noh DY, Im JG (2002) US of ductal carcinoma in situ. Radiographics 22:269–280PubMedGoogle Scholar
  36. 36.
    Yang WT, Tse GM (2004) Sonographic, mammographic, and histopathologic correlation of symptomatic ductal carcinoma in situ. AJR Am J Roentgenol 182:101–110PubMedGoogle Scholar
  37. 37.
    Cho KR, Seo BK, Kim CH et al (2008) Non-calcified ductal carcinoma in situ: ultrasound and mammographic findings correlated with histological findings. Yonsei Med J 49:103–110CrossRefPubMedGoogle Scholar
  38. 38.
    Starvros AT (2004) Malignant solid breast nodules: specific types. In: McAllister L, Donnellan K, Martin SP, Rothschild R (eds) Breast ultrasound. Lippincott Willams & Wilkins, Philadelphia, pp 600–608Google Scholar
  39. 39.
    Alonso-Bartolome P, Vega-Bolivar A, Torres-Tabanera M et al (2004) Sonographically guided 11-G directional vacuum-assisted breast biopsy as an alternative to surgical excision: utility and cost study in probably benign lesions. Acta Radiol 45:390–396CrossRefPubMedGoogle Scholar
  40. 40.
    Johnson AT, Henry-Tillman RS, Smith LF et al (2002) Percutaneous excisional breast biopsy. Am J Surg 184:550–554CrossRefPubMedGoogle Scholar
  41. 41.
    Fine RE, Boyd BA, Whitworth PW, Kim JA, Harness JK, Burak WE (2002) Percutaneous removal of benign breast masses using a vacuum-assisted hand-held device with ultrasound guidance. Am J Surg 184:332–336CrossRefPubMedGoogle Scholar
  42. 42.
    Fine RE, Whitworth PW, Kim JA, Harness JK, Boyd BA, Burak WE Jr (2003) Low-risk palpable breast masses removed using a vacuum-assisted hand-held device. Am J Surg 186:362–367CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Radiology 2009

Authors and Affiliations

  • Ji Hyun Youk
    • 1
  • Eun-Kyung Kim
    • 1
    • 2
  • Min Jung Kim
    • 1
  • Jin Young Kwak
    • 1
  • Eun Ju Son
    • 1
  1. 1.Department of Radiology, Research Institute of Radiological ScienceYonsei University College of MedicineSeoulSouth Korea
  2. 2.Department of RadiologyYonsei University College of MedicineSeoulSouth Korea

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