Accuracy of ultrasound-guided,large-core needle breast biopsy

Ultrasound-guided, large-core needle biopsy (US-LCNB) of suspicious breast lesions is acknowledged as less invasive and less expensive and less time consuming than surgical biopsy, and provides a histologic diagnosis with a comparable high degree. US-LCNB has been proven to help reduce the number of unnecessary surgeries for benign disease. Its limitations, however, are false-negative results and underestimation of disease. Thus, the demand for breast teams is to carefully adhere to the principles of triple assessment and imaging-histologic correlation, and follow-up of lesions with a specific benign histology after biopsy. Also, the acceptance of guidelines and rigorous quality controls help to reliably minimize the delay in the diagnosis of breast cancer in patients with false-negative biopsies. This paper aims to summarize the equipment and methods as well as the benefits and limitations of US-LCNB. Also, guidelines of quality assessment are suggested. Finally, recent developments which may help to overcome the limitations of US-LCNB will be discussed, i.e., directional vacuum-assisted biopsy (VAB), three-dimensional (3D) US-guided biopsy, as well as the use of tissue harmonic imaging (THI) and compound imaging (CI) during biopsy.     

Stereotactic and ultrasound-guided breast biopsy

Percutaneous imaging-guided needle biopsy has increasingly become an alternative to surgical biopsy for the histologic assessment of breast lesions. Percutaneous biopsy is faster, less invasive, and less expensive than surgical biopsy. Tissue acquisition is performed with automated core needles or directional vacuum-assisted biopsy probes. Guidance for percutaneous biopsy is usually provided by stereotaxis, ultrasound, and, more recently, under the guidance of MR imaging. Imaging guidance depends on lesion type and the results of diagnostic imaging studies. This article reviews indications, advantages, limitations, and controversial issues in percutaneous imaging-guided biopsy of breast lesions under stereotactic and ultrasound guidance. The potential for new research opportunities and directions is also discussed.     

Ultrasound-guided breast biopsy using a 10-gauge self-contained vacuum-assisted device

The purpose of this study was to evaluate the diagnostic value of a self-contained battery-driven vacuum-assisted breast biopsy (VABB) system for the sampling of breast masses under ultrasound guidance. Sixty-five patients with 70 lesions underwent percutaneous 10-gauge ultrasound-guided VABB using the coaxial technique. In 38 lesions, subsequent surgery and comparison of histology was performed. The remaining 32 cases were followed-up and defined as true negative after a cancer-free interval of 24 months. VABB revealed malignant histology in 28 (40%) cases. Twenty-four malignancies were confirmed after surgery. Four invasive cancers verified in VABB were not found during surgery because they were completely removed, as proved by a disease-free interval of 24 months. One cancer missed in ultrasound-guided VABB due to its small size was successfully diagnosed with stereotactic VABB and thus turned out to be false negative, resulting in an overall sensitivity of 96.6%. Forty-one patients were free of cancer during the follow-up period of at least 24 months. In conclusion, the self-contained VABB device is well suited for ultrasound-guided breast biopsies.     

Initial clinical experience with a new MRI vacuum-assisted breast biopsy device

PURPOSE: To report initial clinical experience with a new previously unreported vacuum-assisted device (EnCor MR, SenoRx, Aliso Viejo, CA) for magnetic resonance imaging (MRI)-guided breast biopsy and to compare this device with previously reported technologies. MATERIALS AND METHODS: A prospective study of MRI-guided vacuum-assisted breast biopsies using the EnCor device was undertaken. Lesions targeted for biopsy were occult on mammography, ultrasound, and physical examination. Histologic results were obtained for all cases. Patients with benign, concordant results underwent clinical and imaging follow-up. Cases with discordant, high-risk, or malignant results were referred for surgical biopsy. RESULTS: A total of 55 biopsies were performed in 47 patients. All biopsies were technically successful. Histologic results yielded malignancy in 10 (10/55, 18%) of the 55 lesions and high-risk or atypical lesions in 7 (7/55, 13%) of the cases. All of these patients have had surgical follow-up, with four (4/55, 7%) underestimations. There were three (3/55, 5%) discordant cases. 35 (35/55, 64%) lesions yielded benign concordant results. Of these, six (6/35, 17%) lesions were removed surgically, with confirmation of the MR-guided biopsy results. Twenty (20/35, 57%) lesions have undergone at least 6-month follow-up MRI, with resolution or stability of the MRI findings. CONCLUSION: The EnCor breast biopsy device has comparable results to those previously reported for other MRI-guided vacuum-assisted technologies.     

The impact of stereotactic large-core needle biopsy in the treatment of patients with nonpalpable breast lesions: a study of diagnostic accuracy in 510 consecutive cases

The objective of this study was to assess the usefulness of stereotactic large-core needle biopsy (LCNB) in the management of nonpalpable breast lesions (NBL) and compare it with stereotactic fine-needle aspiration biopsy (SFNA) performed simultaneously in a significant number of cases. From November 1993 through June 1997, 510 consecutive patients with NBL underwent 14-gauge LCNB with 354 women undergoing simultaneous 21-gauge SFNA in the same lesion. Mammographic findings, lesion size, number of core biopsy specimens, complications and diagnoses of both techniques were analysed. Surgical biopsy, tumorectomy or mastectomy was indicated for malignancy or poor correlation between SFNA or LCNB results and clinical or radiological findings. Values of diagnostic accuracy of both LCNB and SFNA were determined. The ratio benign surgical biopsies/malignant surgical biopsies (BB/CB) of the series was calculated. A total of 171 patients underwent surgical treatment; in 31 (18.1 %) a benign process or atypical ductal hyperplasia was the final diagnosis. The ratio BB/CB was 0.22. Sensitivity and specificity were 93.2 and 100 %, respectively, for LCNB, and 77.2 and 92.3 %, respectively, for SFNA with cytological analysis. Large-core needle biopsy provides more accurate diagnosis than SFNA in the management of nonpalpable breast lesions and obviates a surgical diagnostic procedure in a significant number of cases. Received 17 November 1997; Revision received 4 February 1998; Accepted 16 March 1998     

Stereotactic breast biopsy with an 8-gauge,directional, vacuum-assisted probe: initial experience

This study was prospectively conducted to assess the feasibility, safety and accuracy of an 8-G directional vacuum-assisted biopsy (DVAB) probe in the diagnostic management of nonpalpable breast lesions (NPBL). Of 170 planned procedures which were indicated for investigation of BI-RADS category-3 to category-5 lesions, 153 were performed in 138 consecutive patients. The probe was targeted by the stereotactic unit of a prone table (United States Surgical Corporation, Norwalk, Conn.; and Lorad, Danbury, Conn.). Four to 18 (mean 8) core specimens were obtained for each lesion. In case of complete removal of the lesion, a localizing clip was deployed at the biopsy site. Adequate material for histopathologic examination was obtained in all cases (100%). Four of 138 (3%) patients experienced mild hematomas. We observed 15 of 39 failures (38%) to place the localizing clips. Thirteen of 153 (8%) procedures were inconclusive and required reintervention. Following DVAB, 42 of 138 (30%) patients underwent surgery. Subject to incomplete follow-up of the entire cohort, we observed no false-positive and one false-negative diagnosis. These preliminary results suggest that DVAB using an 8-G probe are feasible, safe and accurate. In our experience, clip placement was problematic. It is probable that increasing the dimensions of DVAB will only be relevant in a limited number of clinical situations, primarily the desire to obtain complete radiologic resections of the target abnormality.     

弹性成像对超声引导乳腺肿块穿刺活检指导价值研究

目的探讨超声弹性成像对超声引导BI-RADS 4级乳腺肿块穿刺活检的指导价值。方法回顾性分析141例经超声引导下BI-RADS 4级乳腺肿块穿刺活检患者的临床资料。所有患者穿刺前均进行常规超声及弹性成像检查,以BI-RADS分级及弹性评分评价乳腺肿块的良恶性。结果 BI-RADS分级为4a级的阴性预测值(NPV)为89.6%,弹性评分≤3分的NPV为95.5%,两者比较,差异无统计学意义(P>0.05);BI-RADS分级为4b级的阳性预测值(PPV)为59.3%,弹性评分≥4分的PPV为85.3%,两者比较,差异有统计学意义(P<0.05);BI-RADS分级为4c级的PPV为89.7%,弹性评分≥4分的PPV为96.9%,两者比较,差异无统计学意义(P>0.05);BI-RADS分级≥4b级的PPV为72.0%,弹性评分≥4分的PPV为90.9%,两者比较,差异有统计学意义(P<0.05)。结论弹性评分<3分的4a级乳腺肿块可以短期随访观察;弹性评分为5分的4c级乳腺肿块建议直接手术治疗;对于良恶性难以鉴别的4b级乳腺肿块,超声弹性成像可以进一步提高其PPV,建议穿刺活检明确诊断。     

Role of ultrasound in the preoperative staging of patients with breast cancer

The aim of this study was to evaluate the ability of axillary ultrasound (US) and US-guided fine-needle aspiration biopsy (FNAB) to detect axillary LN metastases. Between January 2001 and September 2003, axillary US was performed in 165 patients with cytologically or histologically proven breast cancer and clinically non-palpable axillary LNs. In patients with US suspicious LNs, US-guided FNAB was performed and patients with cytologically proven malignant LNs proceeded directly to the ALND. In 49/90 patients with US suspicious LNs, US-guided FNAB was performed. It was positive in 33/49 patients. Definitive histology report revealed LN metastases in 65/165 patients. The sensitivity, specificity, positive and negative predictive value of the US-FNAB, were 84, 91, 97 and 62%. Axillary US in a combination with US-FNAB is a valuable method in preoperative staging of patients with breast cancer. Almost 50% of patients with LN metastases can be spared the second operation. However, it is very much operator-dependent and equipment-dependent.     

Magnetic resonance-guided biopsy of suspicious breast lesions with a handheld vacuum biopsy device

Purpose: To evaluate a handheld vacuum-assisted device system for magnetic resonance image (MRI)-guided breast lesion biopsy.

Material and Methods: In 32 patients, a total of 42 suspicious breast lesions (mean diameter 7.5 mm for mass lesions, 11.6 mm for non-masslike diffuse lesions) seen with MRI (no suspicious changes in breast ultrasound or mammography) were biopsied (27 lateral, 15 medial) using a 10G vacuum-assisted breast biopsy device under MR guidance. Histology of biopsy specimens was compared with final histology after surgery or follow-up in benign lesions.

Results: In all biopsies, technical success was achieved. Histology revealed 11 lesions with ductal carcinoma in situ (DCIS) or invasive cancer, three with intermediate lesions (LCIS) and 28 with benign breast lesions (adenosis, infected hematoma). In one patient with discordant results of MRI and histology, surgical excision revealed medullary cancer. In the follow-up (mean 18 months) of the histological benign lesions, no breast cancer development was observed. Besides minor complications (hematoma, n = 6), with no further therapeutic interventions, no complications occurred.

Conclusion: MRI-guided breast lesion biopsy using a handheld vacuum-assisted device is a safe and effective method for the work-up of suspicious lesions seen with breast MRI without changes in mammography or ultrasound. In the case of discordant histology of vacuum biopsy and breast MRI appearance, surgical excision is recommended.     

Stereotactic vacuum biopsy of calcifications with a handheld portable biopsy system: a validation study

To prospectively evaluate a compact portable 10-gauge handheld battery-operated biopsy system for stereotactic biopsy of microcalcifications. The ethics committee of the hospital approved this prospective multicentric study, and informed consent was obtained. Biopsy under stereotactic guidance was performed in 215 patients for 219 lesions consisting of microcalcifications without mass. The feasibility and the tolerance of the procedure were evaluated. The mean weight of the specimen was calculated. In patients with surgical diagnoses, the underestimation rate in biopsy diagnoses of atypical ductal hyperplasia and ductal carcinoma in situ were evaluated. The sampled specimens were separated according to the presence of calcifications on magnified specimen radiographs and to the probe the rotation number in order to evaluate the contribution of each rotation and the contribution of the specimen with and without calcifications on the radiographs. The macrobiopsy was feasible in 98.5% of the patients and was well tolerated in 82% of patients. It identified 4.6% invasive carcinomas, 18.5% ductal carcinomas in situ, 14.8% atypical ductal hyperplasias, 22.2% benign proliferative mastopathies and 39.8% benign non-proliferative mastopathies. The underestimation rate was 26.6% when an atypical ductal hyperplasia was diagnosed at biopsy, and 7.7% when a ductal carcinoma in situ was diagnosed. In the 77 patients with surgical correlation, the accurate diagnosis was obtained in specimens sampled during the first, second, and third in 69%, 9%, and 4% of the biopsies, respectively, and the analysis of specimens without microcalcification had an added value in 8% of patients. The compact portable battery-operated biopsy system can be used successfully for stereotactic biopsy of microcalcifications and constitutes a valid alternative to current systems.     

Multicenter study for the evaluation of a dedicated biopsy device for MR-guided vacuum biopsy of the breast

The purpose of this multicenter study was to determine the accuracy and clinical value of a dedicated breast biopsy system which allows for MR-guided vacuum biopsy (VB) of contrast-enhancing lesions. In five European centers, MR-guided 11-gauge VB was performed on 341 lesions. In 7 cases VB was unsuccessful. This was immediately realized on postinterventional images or direct follow-up combined with histopathology-imaging correlation; thus, a false-negative diagnosis was avoided. Histology of 334 successful biopsies yielded 84 (25%) malignancies, 17 (5%) atypical ductal hyperplasias, and 233 (70%) benign entities. Verification of malignant or borderline lesions included reexcision of the biopsy cavity. Benign histologic biopsy results were verified by retrospective correlation with the pre- and postinterventional MRI and by subsequent follow-up. Our results indicate that MR-guided VB, in combination with the dedicated biopsy coil, offers the possibility to accurately diagnose even very small lesions that can only be visualized or localized by MRI.     

超声定位经皮盲穿肾活检术102例分析

目的：为了提高肾脏活检取材成功率和避免严重并发症。方法：根据临床要求，需要肾活检的相关病人，无肾活检禁忌症，在B超定位下，不使用穿刺探头或穿刺架，手动快速穿刺取材。结果：选择102例，成功取材100例(98．3％)，失败2例(1．7％)。术后均无严重的并发症发生。结论：术前充分准备，术中定位精确，取材操作干脆、快速及术后处理规范，是肾活检成功的关键所在。     

Pretreatment axillary ultrasonography and core biopsy in patients with suspected breast cancer: Diagnostic accuracy and impact on management

Preoperative diagnosis of axillary metastases in breast cancer patients enables treatment planning. We aimed to evaluate the diagnostic accuracy of axillary ultrasonography and percutaneous biopsy, both alone and in combination, in detecting axillary metastases in patients with breast cancer and to assess the impact of these techniques on the patients’ management.

Materials and methods

Retrospective study of consecutive patients with suspected breast cancer examined between October 2006 and December 2008. The diagnosis of a primary tumor was histologically confirmed in all patients. All patients underwent axillary ultrasonography and percutaneous core biopsy (14G) of suspicious lymph nodes. We evaluated the morphological characteristics of the lymph nodes by ultrasonography. We calculated the diagnostic accuracy of ultrasonography and of core biopsy, and assessed the impact of these techniques on patients’ treatment.

Results

We evaluated 675 axillary regions and performed 291 core biopsies of axillary lymph nodes in 662 patients. In 650 patients, breast cancer was histologically confirmed and in 12 patients malignant tumors in other locations were confirmed. The sensitivity and specificity of axillary ultrasonography were 63.2% and 88.7%, respectively. The absence of a fatty hilum within the lymph node was the ultrasonographic finding with the highest positive predictive value for malignancy (93.1%). The sensitivity and specificity of axillary core biopsy were 69.1% and 100%, respectively. Sentinel lymph node biopsy was avoided in 33% of initial candidates and immediate breast reconstruction was undertaken in 35.1% of the patients with mastectomy and negative axillary core biopsy.

Conclusions

Ultrasonography and axillary core biopsy enable adequate pretreatment staging in patients with breast cancer and has a positive impact on their management.     

Towards a more sophisticated use of breast ultrasound

The diagnostic role of breast ultrasound has been expanded along with the improvement of high-frequency transducers and digital technology. Vascular assessment has progressed enough to depict normal vascular anatomy of the breast and the lymph nodes. Pathologic vessels are seen in almost all the tumors, thus improving US sensitivity for nonpalpable carcinomas. New contrast agents will recirculate enough to search for vascular foci during a thorough investigation of both breasts and nodal stations. The US role in screening might be now revised. Many factors are now in favor of targeted US screening in dense and complex breasts and in high-risk patients. Screening sensitivity is significantly increased. Most of these US-detected tumors are small enough to be curable. Mammography and sonography together are a unique problem-solving and cost-effective tool. They can easily guide fine aspirations or larger biopsies reducing the cost of unnecessary surgical procedures. Accurate US investigations facilitate the surgical approach to a very conservative and cosmetic operation. High-resolution sonography can demonstrate the intraductal spread of tumors and their multiple foci more easily than mammography, but US diagnosis is less sensitive than magnetic resonance mammography in the evaluation of the real tumoral extent. Ductal branching has a complex pattern; therefore, intraductal spread and multifocal nodes are better demonstrated by multiplanar analysis of 3D ultrasound data volumes. Sonography can easily explore the different nodal chains. Metastatic disease is indicated by an enlarged and round shape and the absence of the echogenic hilum. Irregularities in the cortex are a very useful sign in metastatic nodes without total replacement of lymphoid tissue by neoplastic cells. These signs are very specific. A time-consuming, radiation-emitting and costly sentinel biopsy may be avoided in one of every five clinically node-negative patients. But preoperative US assessment is also important as sonography is very sensitive in patients with extensive nodal involvement that might result negative at the sentinel node procedure. New technologies and contrast agents allow perfusional studies that enhance the contrast resolution and will increase the sensitivity of US for small nodal metastases.     

Use of ultrasound-guided axillary node core biopsy in staging of early breast cancer

The aim of this study was to see how effective ultrasound-guided needle biopsy was at detecting lymph node involvement in patients with early breast cancer. Patients with newly diagnosed invasive breast cancer underwent axillary ultrasound (US) where lymph node size and morphology were noted. A core biopsy (CB) was undertaken of any node greater than 5 mm in longitudinal section. Patients with benign CBs proceeded to sentinel lymph node (SLN) biopsy, whereas those with malignancy underwent axillary lymph node dissection (ALND). US and CB findings were correlated with final surgical histology in all cases. One hundred and thirty-nine patients were examined, of whom 52.5% had lymph node metastases on final histology. One hundred and twenty-one patients (87%) underwent axillary node CB. The overall sensitivity of CB for detecting lymph node metastases was 53.4% (60.3% for macrometastases; 26.7% for micrometastases). The US morphological characteristics most strongly associated with malignancy were absence of a hilum and a cortical thickness greater than 4 mm. However, one third of patients with normal lymph node morphology had nodal metastases, and only 12% of these were diagnosed on CB. CB of axillary lymph nodes can diagnose a substantial number of patients with lymph node metastases, allowing these patients to proceed directly to ALND, avoiding unnecessary SLN biopsy.     

Percutaneous excisional biopsy of clinically benign breast lesions with vacuum-assisted system: comparison of three devices

Purpose

The aim of this study was to compare three devices in percutaneous excisional biopsy of clinically benign breast lesions in terms of complete excision rate, duration of procedure and complications.

Materials and methods

In a retrospective study from March 2005 to May 2009, 983 lesions underwent ultrasound-guided excisional biopsy with three vacuum-assisted systems, respectively. The lesions were category 3 lesions as determined by ultrasound imaging according to Breast Imaging Reporting and Data System (BI-RADS) (n = 951) or had been confirmed as benign by a previous core needle biopsy (n = 32). The completely excision rate, duration of procedure and complications (hematoma, pain and ecchymosis) were recorded.

Results

99.7% (980/983) lesions were demonstrated to be benign by pathology after percutaneous excisional biopsy. The overall complete excision rate was 94.8% (932/983). In lesions whose largest diameter equal to or larger than 1.5 cm, the complete excision rates of EnCor^® group (97.8%, 348/356) and Mammotome^® group (97.2%, 139/143) were significantly higher than that of Vacora^® group (91.9%, 445/484) (P < 0.05). The EnCor^® group (6.6 ± 6.5 min) had a significant less duration than Mammotome^® (10.6 ± 9.3 min) and Vacora^® group (25.6 ± 23.3 min) (P < 0.05). Hematoma occurred more in EnCor^® group and Mammotome^® group than in Vacora^® group (P < 0.05).

Conclusions

All these three vacuum-assisted systems are highly successful for excisional biopsy of benign breast lesions.     

US-guided breast biopsy with an automated cutting needle

The authors report their experience on the use of a biopsy gun for histological sampling in the field of breast lesions. The use of cytological sampling by (FNAB) fine needle aspiration biopsy has been preferred so far, because it has been thoutht to be simpler, less risky and reliable. Nevertheless, the cytological sampling shows a number of drawbacks such as the need for passes to get sufficient cellular material, frequent problems in diagnosing benign lesions and the decisive influence of the operator's skill. By using a biopsy gun for histological sampling these disadvantages are eliminated. In this case, in fact, the validity of the sample is not influenced by the operator's skill; fewer passes are necessary and their validity does not depend on the nature of the lesion. The personal series of cases involves 91 patients subjected to histological sampling for suspected lesions. Two different kinds of needles were used with one an 18 G diameter and a 23-mm extension of the sytlet, as well as a sampling window 17 mm; the other with the same diameter and extension of the stylet, as as a sampling window 8 mm. The first needle was used in all 91 patients, and the second only in 30. The results were not influenced by the employ of the different kinds of needles. A total of 268 samples were made and 110 lesions were discovered, 79 of which were malignant and 31 benign (fibroadenoma, fibrocystic change and epitheliosis). Three carcinomas were not found (3 false-negative) and one specimen was inadequate. The values of sensibility, specificity and diagnostic accuracy of the method were, respectively, 96.2%, 100% and 97.2%, with 3.8% false-negative due to three cases where the lesion was not centred for guidance mistake.     

European quadricentric evaluation of a breast MR biopsy and localization device: technical improvements based on phase-I evaluation

Our purpose was to report about technical success, problems and solutions, as experienced in a first multicentre study on MR-guided localisation or vacuum biopsy of breast lesions. The study was carried out at four European sites using a dedicated prototype breast biopsy device. Experiences with 49 scheduled localisation procedures and 188 vacuum biopsies are reported. Apart from 35 dropped indications, one localisation procedure and 9 vacuum biopsies were not possible (3 times space problems due to obesity, 2 times too strong compression, 3 times impaired access from medially, 2 times impaired access due to a metal bar). Problems due to too strong compression were recognised by repeat MR without compression. During the procedure problems leading to an uncertain result occurred in eight vacuum biopsies, two related to the procedure: one limited access, and one strong post-biopsy enhancement. Improvements after phase-I study concerned removal of the metal bar, development of an improved medial access, of a profile imitating the biopsy gun, optimisation of compression plates and improved software support. The partners agreed that the improvements answered all important technical problems.     

实时超声引导下肾脏活检的临床意义

目的探讨实时超声引导下肾脏穿刺活检技术在肾脏疾病诊断中的实际临床意义。方法对362例临床高度怀疑肾脏实质病变的患者进行经皮超声引导下肾脏穿刺活检,对活检定位的准确性和并发症进行分析。结果362例全部取材成功,均获得满意的病理结果,用时最长30min,最短10min。并发症血尿61例,肾周血肿2例。结论经皮超声引导下肾脏穿刺活检的操作简单,患者痛苦小,操作时间短,准确性好,安全。运用该技术穿刺肾脏有助于肾脏疾病的鉴别诊断,为临床治疗提供依据。     

US correlation for MRI-detected breast lesions in women with familial risk of breast cancer

AIM: To examine the value of US correlation for MRI-detected breast lesions in women with familial risk of breast cancer. METHODS: From an initial dataset of 245 women with positive family history who had breast cancer surveillance involving mammography or MRI between November 1994 and February 2001, 179 subjects with follow-up data were selected. A total of 43 women with 48 MRI-detected lesions underwent further assessment with US. Histopathological correlation was available from 38 breast biopsies performed for 33 women. RESULTS: Sonographic correlates were identified in 32 (66.7%) of the 48 MRI-detected lesions, with cancer present in 11 (34.4%) of these. This compares with 1 (6.3%) cancer found in the 16 lesions without sonographic correlates. Of the 12 malignant lesions, 11 (91.7%) had sonographic correlates whereas 21 (58.3%) of the 36 benign lesions had sonographic correlates. In all 74% of breast biopsies were performed under US guidance compared with 8% under MRI guidance. The proportion of MRI- and US-correlated benign and malignant lesions undergoing US-guided biopsy were 85.7% and 90.9%, respectively. CONCLUSION: The probability of cancer was significantly higher in MRI-detected breast lesions with sonographic correlates compared with those without such correlation. The advantage of convenient biopsy under US guidance as opposed to MRI guidance highlights the value of sonographic assessment of MRI-detected breast lesions.