Sonographically guided 14-gauge core needle biopsy of breast masses: A review of 2,420 cases with long-term follow-up

OBJECTIVE. The objective of our study was to determine the diagnostic accuracy of sonographically guided core needle biopsy for breast masses by evaluating the outcomes of benign biopsies that had at least a 2-year follow-up. MATERIALS AND METHODS. In this retrospective study, we included a total of 2,420 lesions from 2,198 women who had undergone sonographically guided 14-gauge core needle biopsy. For evaluating the diagnostic accuracy of this procedure, the pathologic results were reviewed and correlated with rebiopsy or long-term imaging follow-up. Agreement rate, high-risk underestimate rate, ductal carcinoma in situ (DCIS) underestimate rate, and false-negative rate were assessed. The false-negative diagnoses of core needle biopsy were reviewed in detail. RESULTS. The pathologic results for the core needle biopsies were malignant in 52%, high-risk in 4%, and benign in 44%. The agreement rate was 96% (2,328 of 2,420). The underestimate rate was 29% (36 of 126) for DCIS and 27% (25 of 93) for high-risk (52% for 27 atypical ductal hyperplasia (ADH), 17% for 66 non-ADH). Of 1,071 benign lesions, malignancy was found at rebiopsy in 31 lesions (25 immediate and six delayed false-negative diagnoses), and the false-negative rate was 2.4% (31 of 1,312). The frequency of malignancy in lesions that had rebiopsy because of suspicious imaging findings (19.1%, 26 of 136) was significantly higher than that because of suspicious physical findings or request by patient or physician (0.9%, five of 584). CONCLUSION. Sonographically guided 14-gauge core needle biopsy is an accurate method for evaluating breast masses. Imaging-pathologic correlation and follow-up of benign biopsy are essential for a successful breast biopsy program.