European Radiology

, Volume 27, Issue 7, pp 2928–2933 | Cite as

Comparison of the accuracy of US-guided biopsy of breast masses performed with 14-gauge, 16-gauge and 18-gauge automated cutting needle biopsy devices, and review of the literature

  • Monica L. Huang
  • Kenneth Hess
  • Rosalind P. Candelaria
  • Mohammad Eghtedari
  • Beatriz E. Adrada
  • Nour Sneige
  • Bruno D. Fornage



To compare the diagnostic accuracy of ultrasound (US)-guided core needle biopsy (CNB) of breast masses performed with 14-gauge, 16-gauge and 18-gauge needles.


We retrospectively reviewed the charts of 1,112 patients who underwent US-guided breast CNB with 14-gauge, 16-gauge and 18-gauge needles. Cases with surgical excision or a minimum of 2 years of imaging follow-up were included. Rates of sample inadequacy, discordance with surgical or imaging findings and upgrade of DCIS to invasive cancer or high-risk lesion to in situ or invasive cancer were computed for each needle size.


The study included 703 CNBs: 203 performed with 14-gauge, 235 with 16-gauge and 265 with 18-gauge needles. There were no significant differences between 14-gauge, 16-gauge and 18-gauge needles in rates of specimen inadequacy (0 %, 0.4 % and 1.9 %, respectively) (p = 0.084); surgical discordance (2.6 %, 2.9 % and 3.8 %) (p = 0.76); imaging discordance (0 %, 0 % and 2 %) (p = 1.0); DCIS upgrade (43 %, 43 % and 36 %) (p = 1.00) or high-risk lesion upgrade (38 %, 25 % and 55 %) (p = 0.49).


There was no statistically significant difference in diagnostic accuracy of US-guided CNB of breast masses performed with 14-gauge, 16-gauge and 18-gauge needles.

Key Points

Percutaneous image-guided breast core needle biopsy (CNB) is the standard of care.

Breast CNB with 14-gauge, 16-gauge and 18-gauge needles has similar diagnostic accuracy.

Smaller gauge needles can be confidently used for ultrasound-guided breast CNB.


Breast Biopsy Ultrasound Core Needle 



The scientific guarantor of this publication is Monica L. Huang, MD. The authors declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained for this retrospective study.


  1. 1.
    Parker SH, Lovin JD, Jobe WE et al (1990) Stereotactic breast biopsy with a biopsy gun. Radiology 176:741–747CrossRefPubMedGoogle Scholar
  2. 2.
    Parker SH, Burbank F, Jackman RJ et al (1994) Percutaneous large-core breast biopsy: a multi-institutional study. Radiology 193:359–364CrossRefPubMedGoogle Scholar
  3. 3.
    Fornage BD (1999) Sonographically guided needle biopsy of nonpalpable breast lesions. J Clin Ultrasound 27:385–398CrossRefPubMedGoogle Scholar
  4. 4.
    Mendelson EB, Böhm-Vélez M, Berg WA et al. (2013) ACR BI-RADS Ultrasound. In: ACR BI-RADS Atlas, Breast Imaging Reporting and Data System. Reston, VA, American College of RadiologyGoogle Scholar
  5. 5.
    Krishnamurthy S, Bevers T, Kuerer H et al (2012) Multidisciplinary considerations in the management of high-risk breast lesions. AJR Am J Roentgenol 198:W132–W140CrossRefPubMedGoogle Scholar
  6. 6.
    Nath ME, Robinson TM, Tobon H et al (1995) Automated large-core needle biopsy of surgically removed breast lesions: comparison of samples obtained with 14-, 16-, and 18-gauge needles. Radiology 197:739–742CrossRefPubMedGoogle Scholar
  7. 7.
    Helbich TH, Rudas M, Haitel A et al (1998) Evaluation of needle size for breast biopsy: comparison of 14-, 16-, and 18-gauge biopsy needles. AJR Am J Roentgenol 171:59–63CrossRefPubMedGoogle Scholar
  8. 8.
    Nguyen M, McCombs MM, Ghandehari S et al (1996) An update on core needle biopsy for radiologically detected breast lesions. Cancer 78:2340–2345CrossRefPubMedGoogle Scholar
  9. 9.
    Schoonjans JM, Brem RF (2001) Fourteen-gauge ultrasonographically guided large-core needle biopsy of breast masses. J Ultrasound Med 20:967–972CrossRefPubMedGoogle Scholar
  10. 10.
    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 20:43–49CrossRefPubMedGoogle Scholar
  11. 11.
    Crystal P, Koretz M, Shcharynsky S et al (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
  12. 12.
    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
  13. 13.
    Youk JH, Kim EK, Kim MJ et al (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
  14. 14.
    Margolin FR, Leung JW, Jacobs RP et al (2001) Percutaneous imaging-guided core breast biopsy: 5 years’ experience in a community hospital. AJR Am J Roentgenol 177:559–564CrossRefPubMedGoogle Scholar
  15. 15.
    Uematsu T, Kasami M, Uchida Y et al (2007) Ultrasonographically guided 18-gauge automated core needle breast biopsy with post-fire needle position verification (PNPV). Breast Cancer 14:219–228CrossRefPubMedGoogle Scholar
  16. 16.
    Lai HW, Wu HK, Kuo SJ et al (2013) Differences in accuracy and underestimation rates for 14- versus 16-gauge core needle biopsies in ultrasound-detectable breast lesions. Asian J Surg 36:83–88CrossRefPubMedGoogle Scholar
  17. 17.
    Zhou JY, Tang J, Wang ZL et al (2014) Accuracy of 16/18G core needle biopsy for ultrasound-visible breast lesions. World J Surg Oncol 12:7CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Brenner JR, Fajardo L, Fisher PR et al (1996) Percutaneous core biopsy of the breast: effect of operator experience and number of samples on diagnostic accuracy. AJR Am J Roentgenol 166:341–346CrossRefPubMedGoogle Scholar
  19. 19.
    Kirshenbaum K, Keppke A, Hou K et al (2012) Reassessing specimen number and diagnostic yield of ultrasound guided breast core biopsy. Breast J 18:464–469CrossRefPubMedGoogle Scholar
  20. 20.
    Perrot N, Jalaquier-Coudray A, Frey I et al (2013) US-guided core needle biopsy: false-negatives. How to reduce them? Eur J Radiol 82:424–426CrossRefPubMedGoogle Scholar
  21. 21.
    de Lucena CE, Dos Santos Junior JL, de Lima Resenda CA et al (2007) Ultrasound-guided core needle biopsy of breast masses: how many cores are necessary to diagnose cancer? J Clin Ultrasound 35:363–366CrossRefPubMedGoogle Scholar
  22. 22.
    Park AY, Gweon HM, Son EJ et al (2014) Ductal carcinoma in situ diagnosed at US-guided 14-gauge core-needle biopsy for breast mass: preoperative predictors of invasive breast cancer. Eur J Radiol 83:654–659CrossRefPubMedGoogle Scholar
  23. 23.
    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 180:347–351CrossRefPubMedGoogle Scholar
  24. 24.
    Mesurolle B, Perez JC, Azzumea F et al (2014) Atypical ductal hyperplasia diagnosed at sonographically guided core needle biopsy: frequency, final surgical outcome, and factors associated with underestimation. AJR Am J Roentgenol 202:1389–1394CrossRefPubMedGoogle Scholar
  25. 25.
    Houssami N, Ciatto S, Ellis I et al (2007) Underestimation of malignancy of breast core-needle biopsy: concepts and precise overall and category-specific estimates. Cancer 109:487–495CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Radiology (outside the USA) 2016

Authors and Affiliations

  • Monica L. Huang
    • 1
  • Kenneth Hess
    • 1
  • Rosalind P. Candelaria
    • 1
  • Mohammad Eghtedari
    • 2
  • Beatriz E. Adrada
    • 1
  • Nour Sneige
    • 3
  • Bruno D. Fornage
    • 1
  1. 1.The University of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.UC San Diego Health SciencesLa JollaUSA
  3. 3.The University of Texas MD Anderson Cancer CenterHoustonUSA

Personalised recommendations