Intravascular Ultrasound-Guided Transvenous Biopsy of Abdominal and Pelvic Targets Difficult to Access by Percutaneous Needle Biopsy: Technique and Initial Clinical Experience

PurposeTo report initial clinical experience with intravascular ultrasound (US)-guided transvenous biopsy (TVB) for perivascular target lesions in the abdomen and pelvis using side-viewing phased-array intracardiac echocardiography catheters.Materials and MethodsIn this single-institution, retrospective study, 48 patients underwent 50 intravascular US-guided TVB procedures for targets close to the inferior vena cava or iliac veins deemed difficult to access by conventional percutaneous needle biopsy (PNB). In all procedures, side-viewing phased-array intracardiac echocardiography intravascular US catheters and transjugular liver biopsy sets were inserted through separate jugular or femoral vein access sheaths, and 18-gauge core needle biopsy specimens were obtained under real-time intravascular US guidance. Diagnostic yield, diagnostic accuracy, and complications were analyzed.ResultsIntravascular US-guided TVB was diagnostic of malignancy in 40 of 50 procedures for a diagnostic yield of 80%. There were 5 procedures in which biopsy was correctly negative for malignancy, with a per-procedure diagnostic accuracy of 90% (45/50). Among the 5 false negatives, 2 patients underwent repeat intravascular US-guided TVB, which was diagnostic of malignancy for a per-patient diagnostic accuracy of 94% (45/48). There were 1 (2%) mild, 2 (4%) moderate, and 1 (2%) severe adverse events, with 1 moderate severity adverse event (venous thrombosis) directly attributable to the intravascular US-guided TVB technique.ConclusionsIntravascular US-guided TVB performed on difficult-to-approach perivascular targets in the abdomen and pelvis resulted in a high diagnostic accuracy, similar to accepted thresholds for PNB. Complication rates may be slightly higher but should be weighed relative to the risks of difficult PNB, surgical biopsy, or clinical management without biopsy.     

Interactive MR-guided biopsies of maxillary and skull-base lesions in an open-MR system: first clinical results

The purpose of this study was to explore the potential of interactive MR-guided biopsies in the maxillary and skull base region using a 0.5-T open-configuration scanner in patients with tumours affecting the maxilla or skull base. Ten patients with cystic or solid tumours affecting the maxillary and skull base regions underwent MR-guided biopsy in a superconducting, open 0.5-T MR system equipped with an optical frameless stereotaxic system. T2-weighted spin-echo images were acquired prior to and following biopsy, which was performed with 18- or 22-G needles using an enoral or percutaneous approach following infiltration of the skin, mucosa and periosteum with local anaesthetics. The position of the needle tip was continuously updated on fast T1-weighted gradient-recalled-echo images (TR 19 ms, TE 7.1 ms, flip angle 30 °, slice thickness 1 cm, field of view 24 × 24 cm) using the frameless stereotaxic system. In addition, the needle was identified based on the associated susceptibility artefact in all three planes. Once the target lesion had been reached, cytology material was aspirated. All ten patients tolerated the interactive MR-guided biopsies well without complications. Vital structures, including the brain, neurovascular bundles, vessels and eyes, were visualized on MR imaging and could be spared. There was no difference in the use of 18- or 22-G non-ferromagnetic needles concerning the susceptibility artefact. Sufficient material for cytological analysis was obtained in nine of ten cases. The mean biopsy time was 15 min. Interactive MR-guided biopsies of the head and neck in an open system are technically feasible and safe. Monitoring of the needle path in multiple planes permits the interactive adjustment of the needle course in near real time. Interactive MR-guided biopsies may well replace open surgical procedures in the maxillary region in selected patients. Received: 26 May 1998; Revision received: 18 August 1998; Accepted: 7 September 1998     

Safety and efficacy of fluoroscopic versus ultrasound guidance for core liver biopsies in potential living related liver transplant donors: preliminary results

PURPOSE: To describe and evaluate the safety and efficacy of fluoroscopically guided percutaneous liver biopsies in comparison with ultrasound (US)-guided percutaneous liver biopsies in potential living related liver donors. MATERIALS AND METHODS: Retrospective analysis of 133 consecutive preoperative workups of potential living related liver donors was performed. The subjects were treated from January 1999 through May 2002. Subjects were divided into those who underwent US-guided subcostal 18-gauge core liver biopsies (group I) and those who underwent fluoroscopically guided intercostal 18-gauge core liver biopsies (group II). Group II biopsies were performed in a manner similar to percutaneous transhepatic cholangiography. All samples obtained during the study period were reevaluated prospectively by a transplant pathologist blinded to guidance modality for sample adequacy (defined as >or=5 complete portal triads). Subjects were followed for 4 hours before discharge and afterward in the transplant clinic until donation. Subjects who did not donate organs were followed for at least 1 month. RESULTS: One hundred thirty-three potential donors were evaluated (55 for group I, 78 for group II). Mean follow-up was 1.7 months, and 77% of subjects donated. The mean numbers of needle passes were 2.1 and 2.3 for groups I and II, respectively. No major complications were encountered, and all subjects were discharged in 4 hours. Incidences of minor complications were 3.6% (vasovagal reactions) and zero for groups I and II, respectively. Sample adequacy rates were 100% and 99% for groups I and II, respectively. One case (1.8%) in group I, although pathologically adequate, had additional renal tissue. CONCLUSION: Fluoroscopically guided liver biopsy shows encouraging initial safety results and is as effective as US-guided liver biopsy in normal subjects.     

Breast lesions with imaging-histologic discordance during US-guided 14G automated core biopsy: can the directional vacuum-assisted removal replace the surgical excision? Initial findings

The purpose of this study was to determine the frequency of carcinoma at percutaneous directional vacuum-assisted removal (DVAR) in women with imaging-histologic discordance during ultrasound (US)-guided automated core needle biopsy, and to determine the role of DVAR in breast lesions with imaging-histologic discordance. A US-guided 14-gauge automated core needle biopsy was performed on 837 consecutive lesions. Imaging-histologic discordance was prospectively considered in 33 of 634 benign biopsies. DVAR was recommended in those lesions. Among the 33 lesions, 26 lesions that underwent subsequent DVAR or surgical excision made up our study population. Medical records, imaging studies, and histologic findings were reviewed. Among the 26 lesions, 18 lesions underwent subsequent US–guided DVAR, with 8-gauge probes for 15 of the lesions, and 11-gauge for three of the lesions. Two lesions were diagnosed as having carcinoma (2/18, 11.1% of upgrade rate; 3.1–32.8% CI). The remaining eight lesions underwent subsequent surgical excision, and carcinoma was diagnosed in one case (12.5% of upgrade rate; 2.2–47.1% CI). A US-guided DVAR of the breast mass with imaging-histologic discordance during US-guided 14-gauge automated core needle biopsy is a valuable alternative to surgery as a means of obtaining a definitive histological diagnosis. An erratum to this article can be found at     

US-guided core biopsy of the spleen in children

PURPOSE: To evaluate the safety, diagnostic yield, and clinical benefits of performing ultrasonography (US)-guided percutaneous splenic core biopsy in children. MATERIALS AND METHODS: US-guided splenic core biopsy was performed in 30 children aged 6 months to 15.3 years (mean, 7.0 years), with focal lesions in 27 patients and homogeneous splenomegaly in three. Four patients underwent repeat biopsy to identify changes in splenic disease. Four types of biopsy needles were used in this series. General anaesthesia was used in 21 patients and conscious sedation in nine. Medical records were reviewed to assess diagnostic accuracy, influence on treatment, and biopsy-related complications. RESULTS: All biopsies were performed without complication. Among the 30 biopsies, an accurate diagnosis was obtained in 25 (83%), a false-negative result was obtained in two (7%), and three (10%) were nondiagnostic. All conclusive results influenced treatment decisions. The mean number of needle passes was 2.7 per patient (range, 2-5 passes). Use of needles was 50%-100% successful in the acquisition of adequate tissue cores. Use of the 18-gauge needle was always successful in the safe acquisition of adequate tissue, with a maximum of three passes. CONCLUSION: US-guided splenic core biopsy is a minimally invasive, simple, and safe procedure for use in children. It provides relatively high diagnostic accuracy while minimizing complications when compared with alternative, more invasive procedures.     

Dynamic contrast-enhanced MR imaging and MR-guided bone biopsy on a 0.23 T open imager

OBJECTIVE: To assess the feasibility of MR (magnetic resonance)-guided bone biopsies. DESIGN AND PATIENTS: Thirty-six consecutive patients with known or suspected benign or malignant bone lesions underwent comprehensive MR imaging. A dynamic contrast-enhanced sequence followed by stationary T1-weighted sequences were obtained and MR-guided bone biopsy of the tumor at the site with fastest enhancement was performed using an open 0.23 T MR imager. RESULTS: All MR-guided bone biopsies samples were estimated to be sufficient by the pathologists. The biopsy specimens were diagnostic in 34 of 36 cases. CONCLUSION: MR-guided bone biopsies combined with dynamic contrast-enhanced imaging are feasible and safe for the diagnostic investigation of equivocal bone lesions.     

MRI引导下骨骼肌肉病变活检的应用价值

目的：介绍iPath200辅助MPI引导下骨骼肌肉系统活检的技术操作方法，并评价其应用价值。方法：24例骨骼肌肉系统病变患者，均在iPath200辅助MPI引导下进行经皮活检。所用设备为Philips公司生产的开放式0．23T。常导磁共振检查仪(Proview)，并配有iPath200光学引导系统。活检针采用德国Daum公司的磁共振兼容性活检针。24例病人中的6例在活检中行Nil对比增强检查。所用对比剂为Gd-DTPA。24例病人中的10例后来行外科手术治疗或活检。结果：MPI引导活检取得足够的标本，所有的病例均获得了组织病理学诊断(24／PA)。在10例后来行外科手术治疗或活检的病人中，初步诊断与最终诊断基本符合(10／10)。未发现明显并发症如严重出血及神经损害等。结论：iPath200辅助MPI引导下的骨骼肌肉系统病变的经皮活检是一种安全、准确的新技术。     

MR-guided biopsies with a newly designed cordless coil in an open low-field system: Initial findings

The purpose of this study was to examine the feasibility and safety of MR-guided biopsies with a newly designed cordless coil in an open low-field magnetic resonance (MR) system. Eleven patients were biopsied using a low-field system (0.2 T, Magnetom Concerto, Siemens) by using the new cordless coil (Siemens). The biopsies were performed in different organ systems [liver (n=7), abdomen (n=1), shoulder (n=1), pelvis (n=1) and hip (n=1)]. The procedures were guided using T1-weighted FLASH (fast low-angle shot) sequences. The lesions were biopsied using the coaxial technique through a 15-gauge puncture needle with a 16-gauge biopsy handy. Coil handling, image quality and complications were evaluated. Imaging quality and visualization of the lesions were optimal up to a penetration depth of 9 cm. In all cases the biopsy procedures were successfully performed with MR guidance without any complications. Pathological findings revealed seven cases of malignant tissue and four cases of non-malignant tissue. The use of the cordless coil allows improved patient access during the biopsy and an improved handling of the coil system. MR-guided biopsy using the novel cordless coil system can be performed safely and precisely with easy handling of the coil. This coil concept, however, is restricted to special indications.     

Single-Pass Percutaneous Liver Biopsy for Diffuse Liver Disease Using an Automated Device: Experience in 154 Procedures

Purpose: To describe our experience with ultrasound (US)-guided percutaneous liver biopsies using the INRAD 18G Express core needle biopsy system. Methods: One hundred and fifty-four consecutive percutaneous core liver biopsy procedures were performed in 153 men in a single institution over 37 months. The medical charts, pathology reports, and radiology files were retrospectively reviewed. The number of needle passes, type of guidance, change in hematocrit level, and adequacy of specimens for histologic analysis were evaluated. Results: All biopsies were performed for histologic staging of chronic liver diseases. The majority of patients had hepatitis C (134/153, 90.2%). All patients were discharged to home after 4 hr of postprocedural observation. In 145 of 154 (94%) biopsies, a single needle pass was sufficient for diagnosis. US guidance was utilized in all but one of the procedures (153/154, 99.4%). The mean hematocrit decrease was 1.2% (44.1–42.9%). Pain requiring narcotic analgesia, the most frequent complication, occurred in 28 of 154 procedures (18.2%). No major complications occurred. The specimens were diagnostic in 152 of 154 procedures (98.7%). Conclusions: Single-pass percutaneous US-guided liver biopsy with the INRAD 18G Express core needle biopsy system is safe and provides definitive pathologic diagnosis of chronic liver disease. It can be performed on an outpatient basis. Routine post-biopsy monitoring of hematocrit level in stable, asymptomatic patients is probably not warranted.     

MR-guided transgluteal biopsies with an open low-field system in patients with clinically suspected prostate cancer: technique and preliminary results

The purpose of this study was to examine the feasibility and safety of MR-guided biopsies with a transgluteal approach in patients with uncertain or suspicious prostate lesions. Twenty-five patients with uncertain or suspicious focal prostate lesions detected by high-field MR imaging of the prostate gland using endorectal coil imaging were biopsied with a transgluteal approach in a low-field MRI system (0.2 T, Concerto, Siemens). The procedures were guided using T1-weighted FLASH sequences. The prostate gland was biopsied repeatedly with a coaxial technique through a 15-gauge pencil tip with a 16-gauge biopsy handy (median 3.8 samples per patient). Complications and biopsy findings were documented retrospectively. Using T1-weighted sequences biopsy procedures were performed successfully with MR guidance in all cases without any side effects or complications. The median intervention time was 11.3 min. Pathological findings revealed ten cases of hyperplasia or atrophy, three cases of prostatitis, ten cases of carcinoma and two cases of normal tissue. The clinical follow-up showed that in two patients prostate cancer was missed at MR-guided biopsy. Transgluteal MR-guided biopsy of the prostate gland is a safe and promising approach for histological clarification of uncertain or suspicious lesions.     

MR-guided core biopsies using a closed 1.0 T imager. First clinical results.

OBJECTIVE: High soft-tissue contrast and multiplanar imaging capabilities of MRI may be advantageous in biopsy guidance compared to CT. We report our first results with MR-guided core biopsies using a closed 1.0 T MR imager. METHODS AND PATIENTS: In ten patients, seven liver lesions and one lesion each in the muscle of the back, the gluteal muscle and in the breast were biopsied under MR guidance using MR-compatible needles (Tru-Cut type, 18G and 14G). For control scans T1-weighted turbo-spin-echo (TSE), gradient-echo and T2-weighted TSE sequences were used. RESULTS: In all patients, the suspicious lesions and the biopsy needle were exactly delineated in MR control scans. In nine out of ten patients, the suspicious lesion was clarified histologically. Controls of needle position in a second plane were performed twice. Pushing the inner stylet alone resulted in a distortion of the needle in several cases in its flat area. The small diameter of the MR gantry was inconvenient for a few patients. One complication (intrahepatic bleeding) was observed, which healed up without consequences. CONCLUSION: Using a closed 1.0 T MR imager MR-guided core biopsies can be conducted efficiently. Core biopsies should be taken by pulling and pushing the outer cannula. Advantageous compared to CT are the multiplanar imaging capabilities, while the smaller gantry is disadvantageous.     

Palpable masses in the prostate: superior accuracy of US-guided biopsy compared with accuracy of digitally guided biopsy

The accuracies of digitally guided biopsy versus ultrasound (US)-guided biopsy of the prostate were compared in 112 consecutive men with palpable prostatic lesions who had previously undergone conventional digitally guided biopsy and in which the results were negative for carcinoma. US-guided biopsies were performed with either the transperineal (n = 51) or transrectal (n = 61) approach, by means of previously described methods. All US-guided biopsies were performed within 3 months after the most recent conventional biopsy. In 44 patients (39.3%) with negative results of conventional biopsies, the results of US-guided biopsy revealed cancer. The transrectal and transperineal digitally guided biopsies were equally inaccurate, and the transrectal and transperineal US-guided biopsies showed no statistically significant differences in accuracy. The patients accepted and tolerated both US techniques equally well; neither technique was associated with significant complications. It is concluded that all patients with a palpable nodule should undergo US-guided biopsy if the result of conventional digitally guided biopsy is negative for cancer and the diagnostic US scan suggests an abnormality.     

MRI-guided abdominal biopsy in a 0.23-T open-configuration MRI system

The purpose of this study was to test the hypothesis that when ultrasound (US) guidance is not feasible, abdominal biopsies can be performed safely and accurately under magnetic resonance imaging (MRI) guidance in a low-field environment. MRI-guided abdominal biopsy was performed on 31 consecutive patients, in whom US-guided abdominal biopsy was not possible because the lesion was not visualized in US (n=27) or an US-guided procedure was not considered safe (n=4). The locations of the lesions were liver (n=14), pancreas (n=6), lymph node (n=4), retroperitoneal mass (n=3), adrenal gland (n=3) and spleen (n=1). The average size of the lesion was 2.2 cm (range 1–4 cm) in maximum diameter. All procedures were done by using a 0.23-T open-configuration C-arm-shaped MRI scanner with interventional optical tracking equipment and software. Fine-needle aspiration (FNA) biopsy was performed on all 31 patients; 18 patients underwent both FNA biopsy and cutting needle core biopsy. Procedures were evaluated for diagnostic sensitivity, specificity and accuracy as well as procedure time and complications. The FNA biopsy specimens were adequate for interpretation in 27 (87%) of 31 cases. Two of these proved to be false-negative findings during follow-up or subsequent biopsy. The final diagnosis was malignant in 15 and benign in 16 patients. The sensitivity, specificity and accuracy of FNA biopsy were 71, 100 and 81%, respectively. Of the 18 core-needle biopsies, one was determined false-negative owing to nonrepresentativeness. The sensitivity, specificity and accuracy of histological samples were 90, 100 and 94%, respectively. The needle time was 19 min on average and the mean room time was 1 h 48 min. No immediate or late complications occurred. MRI-guided abdominal biopsy can be performed safely and accurately in a low-field environment in patients for whom an US-guided procedure is not feasible.     

Head and neck lymphadenopathy: evaluation with US-guided cutting-needle biopsy

PURPOSE: To evaluate ultrasonography (US)-guided core biopsy in the assessment of 247 patients with cervicofacial lymphadenopathy. MATERIALS AND METHODS: Two hundred sixty US-guided core biopsies were performed in 247 patients with cervicofacial lymphadenopathy. The age of the patients ranged from 1 to 91 years (mean, 50 years). Seventy-four (30%) had a history of malignancy. Biopsies were performed as outpatient procedures with direct US guidance and non-advancing 16-18-gauge core needles. Hospital records were reviewed 6 months to 5 years after biopsy. Final diagnoses were rendered based on results of histologic examination of excised specimens, clinical course, or results of other laboratory studies. RESULTS: Two hundred thirty-eight (92%) core biopsies yielded adequate material. In 28 (11%) patients, the histologic diagnosis was considered highly probable. In the 210 patients in whom adequate material was obtained and an unequivocal histologic diagnosis was given, the sensitivity, specificity, and accuracy of US-guided core needle biopsy in differentiating benign from malignant lymphadenopathy were 98.1%, 100%, and 98.7%, respectively. Seventy biopsies were performed in 66 patients with lymphoma. Sensitivity, specificity, and accuracy in differentiating lymphoma from reactive lymphadenopathy were 98.5%, 100%, and 98.7%, respectively. In 53 patients (80%) with lymphoma as a final diagnosis, histologic subclassification was sufficient to guide treatment without the need for surgical biopsy. There were no major complications and only three minor post-biopsy hematomas. CONCLUSION: US-guided core biopsy in patients with head and neck lymphadenopathy is a safe outpatient procedure that has a high diagnostic yield and accuracy and frequently obviates surgery.     

MR-guided biopsy of musculoskeletal lesions in a low-field system

Thirty magnetic resonance (MR)-guided biopsies were obtained from 20 skeletal and 10 soft-tissue lesions in 31 patients using an open 0.2 T MR system equipped with interventional accessories. The results from aspiration (N = 3), core biopsy (N = 15), and transcortical trephine biopsy (N = 12) were evaluated for accuracy and clinical efficacy. Specimens were successfully obtained from 29 patients. Results were clinically effective in 23 patients, rated definitive in 16, nonconclusive in 9, and unspecific in 2 patients. A false diagnosis due to sampling error occurred in 2 patients, and biopsy sampling was impossible in one case. The best diagnostic yield was achieved from nontranscortical biopsies of osteolytic or soft-tissue masses. Results from transcortical biopsies were less specific due to the predominance of benign lesions. MR fluoroscopy for needle guidance was applied in 13 patients. Complete needle placement inside the magnet could be performed in 16 patients. MR-guided biopsy using an open low-field MR imager is feasible and clinically effective and will become a valuable tool in the management of musculoskeletal lesions. J. Magn. Reson. Imaging 2001;13:761-768.     

Routine ultrasound-guided liver biopsy versus echo-assisted procedure in viral chronic hepatitis

PURPOSE: Ultrasound (US)-assisted liver biopsy is the most widespread practice for the staging of chronic hepatitis, but there are no data about a comparison with the US-guided procedure in terms of safety and diagnostic yield. The aim of this study was a retrospective analysis about 357 biopsies performed by using both these techniques. MATERIALS AND METHODS: We analysed 176 US-guided biopsies and and 181 US-assisted liver biopsies performed in the same unit in patients with chronic viral hepatitis. We recorded the number of passes, sample fragmentation and sample size, number of portal spaces and degree of fibrosis. Mortality and morbidity were also assessed. Differences between the two groups of needle biopsies were analysed statistically by the Welch test, with significance at p<0.05. RESULTS: Specimens obtained by US-guided liver biopsy were 27 mm long (range 25-28.9 mm) versus 13 mm mean value (range 12.2-13.9 mm, p<0.0001) of samples from US-assisted liver biopsies and contained 15.7 portal tracts (range 14.7-16.7) versus 11 mean value (range 10-11.9, p<0.0001) of specimens obtained by echo-assisted needle biopsy. Mortality and major complication rate was zero in our series. Both groups of liver biopsies were comparable with respects to number of passes and sample fragmentation. CONCLUSIONS: Both methods showed overlapping security. The diagnostic yield seems to be greater if liver biopsy is performed by the echo-guided technique.     

MR-guided liver biopsy within a short, wide-bore 1.5 Tesla MR system

The purpose of this study was to evaluate the diagnostic efficacy of magnetic resonance (MR)-guided biopsy of focal liver lesions within a short, wide-bore 1.5-T MR system and to determine the duration and accuracy of needle placement using MR fluoroscopy guidance in 25 patients. Accuracy of needle placement was evaluated in two orthogonal planes, and the out-of-plane angle of needle deflection was measured. Needle positioning was characterised subjectively as centred, peripheral, or exterior relative to the lesion. Exterior positioning was corrected by a step-by-step procedure. Surgical resection (n = 6), previous histologies (n = 8), or clinical/radiological follow-up (n = 11) served as the ‘gold standard’. The guidance needle could be placed successfully using MR fluoroscopy in 20 of 25 patients (80%). Needle placement was rated as ‘centred’ in 11 and as ‘peripheral’ in nine patients. Median needle deflection was 2.6 degrees, with a median deviation of 3.4 mm. In five patients, the direct approach failed or was rated as ‘exterior’; therefore, repositioning after needle stabilisation with a stainless-steel stylet was necessary. The diagnostic yield of all biopsies was: sensitivity 95.5%, specificity 100.0% and accuracy 96.0%. In conclusion, MR-guided biopsies in a short, wide-bore MR system yielded highly reliable biopsy results, and in most cases the direct approach with MR fluoroscopy guidance proved to be fast and accurate.     

Ultrasound-guided core needle biopsy as an initial diagnostic test for palpable breast masses.

PURPOSE: To determine the role of ultrasound (US)-guided core needle biopsy as an initial diagnostic test for palpable breast masses. MATERIALS AND METHODS: Ninety-eight consecutive patients, each with a palpable breast mass, were referred for US-guided core biopsy by a multidisciplinary team of physicians who specialize in the care of breast diseases. All palpable breast masses were clearly visible on high-resolution US. Ninety-nine core needle biopsies were performed under local anesthesia with use of freehand technique, mostly in an outpatient setting. Core needle path through each mass was documented in two orthogonal sections. A mean of 3.4 tissue core samples (range, 1-7) were obtained in each patient. RESULTS: Core needle biopsy resulted in the diagnosis of 66 malignancies, two cases of atypical ductal hyperplasia (ADH), and 30 benign diseases of the breast. Surgery with curative intent was performed in 63 breast malignancies and excisional biopsies were performed for 10 benign diseases (two cases of ADH and eight benign lesions). Twenty-five breast masses were managed nonoperatively: chemotherapy was performed in three locally advanced breast cancers and 3-year follow-up was conducted for 22 benign lesions. Malignancies were correctly diagnosed in all cases. No malignancy was discovered at surgery or during clinical follow-up of ADH and no benign breast lesions were diagnosed by core needle biopsy. US-guided core needle biopsy is 100% sensitive and specific for palpable breast malignancies, with no false-positive results. A puncture site ecchymosis was the only morbidity or complication noted. CONCLUSION: US-guided core needle biopsy is a safe and accurate first diagnostic test for palpable breast masses that require tissue proof.     

Ultrasound-guided core needle biopsy of non-palpable breast lesions: a prospective analysis in 204 cases

Purpose: To assess the diagnostic value of ultrasound (US)-guided 14 G core needle breast biopsy in non-palpable suspicious breast lesions.

Material and Methods: From August 1997 to April 2001, 198 patients with 204 suspicious non-palpable breast lesions underwent US-guided large core needle biopsy. Biopsies were performed with a free-hand technique using US equipment with a 7.5 MHz linear-array transducer; a minimum of three cores were obtained from each lesion. Pathological findings in US-guided core biopsy were correlated to findings in subsequent surgery or long-term (more than 2 years) imaging follow-up.

Results: Among the 204 non-palpable breast lesions for which histopathological findings were obtained by US-guided core biopsy, 118 were malignant (114 carcinoma, 2 metastasis, 1 lymphoma, and 1 malignant phyllodes tumor) and 86 were benign (4 carcinoma and 82 benign lesions confirmed at surgery or after at least 2 years of follow-up). Sensitivity, specificity, positive predictive value, and negative predictive value for diagnosis of malignancy in our series were 97%, 100%, 100%, and 95%, respectively. Diagnostic yield with 1, 2, 3, and 4 specimens per lesion was 73.5%, 88%, 94%, and 97.5%, respectively.

Conclusion: US-guided core needle biopsy is a sensitive percutaneous biopsy method for diagnosing non-palpable breast lesions. To achieve a high diagnostic yield, a minimum number of three cores per lesion is advisable.     

US-guided core-needle biopsy of the breast: how many specimens are necessary?

PURPOSE: To analyze the diagnostic yield for each specimen obtained at 14-gauge ultrasonography (US)-guided breast biopsy and compare these findings with mass, procedural, and specimen characteristics that could affect yield. MATERIALS AND METHODS: Seventy-three consecutive biopsies of breast masses were performed by using a 14-gauge handheld biopsy device. Each specimen was graded for whether it was nonfragmented or fragmented and for whether it sank or floated, and each pass was graded for whether or not the needle passed through the lesion. Each specimen was mounted on a separate slide. A pathologist who was unaware of the final diagnoses reviewed the slides in random order. A diagnosis was determined for each specimen whenever possible, and diagnostic yield was calculated as a function of number of passes. The Fisher exact test was used to compare yield for different specimen characteristics. RESULTS: Fourteen (19%) lesions were malignant and 59 (81%) were benign. Cells indicating the final diagnosis were contained in 249 (75%) of 334 specimens. Cells indicating the diagnosis were contained in the first specimen in 51 (70%) lesions, in the second specimen in 67 (92%), in the third specimen in 70 (96%), and in the fourth specimen in 73 (100%). Of the 14 malignancies, 13 (93%) were diagnosed with cells contained in the first or second specimen; one cancer (ductal carcinoma in situ) was diagnosed with cells contained in the fourth specimen. Specimens that were nonfragmented (P <.001) and sank (P <.001) showed correlation with being diagnostic, but needle visualization within the lesion did not. CONCLUSION: A minimum of four specimens, preferably those that are nonfragmented and that sink, should be obtained with 14-gauge US-guided breast biopsy.