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Sonographically guided core biopsy of the breast: comparison of 14-gauge automated gun and 11-gauge directional vacuum-assisted biopsy methods.

Author(s): Cho N, Moon WK, Cha JH, Kim SM, Kim SJ, Lee SH, Chung HK, Cho KS, Park IA, Noh DY

Publication: Korean J Radiol, 2005, Vol. 6, Page 102-9

PubMed ID: 15968149 PubMed Review Paper? No

Purpose of Paper

Conclusion of Paper

Studies

1. Study Purpose

   This study compared the underestimation rate of sonographically-guided core biopsies obtained with a 14-gauge automated gun and with those obtained with an 11-gauge VAD and investigated the effects of lesion size, BI-RADS category, and lesion type on the underestimation rate. A total of 979 breast lesions from 940 patients were biopsied using a 14-gauge automated gun (562 lesions from 525 patients) or an 11-gauge VAD (417 lesions from 425 patients). The VAD was preferred for calcified lesions, intraductal lesions, and solid nodules of less than 1.0 cm and the automated gun was preferred for multifocal lesions and for the lesions in the subareolar or axillary area. The average number of cores obtained with the 14-gauge gun was lower than that obtained with the 11-gauge VAD (4.5 versus 10.2). Final diagnosis was based on surgical excision or follow-up at 6, 12, or 24 months.

   Summary of Findings:

   Of the 22 cases biopsied with the 14-gauge gun and diagnosed as ADH or DCIS, twelve (56%) were upgraded (from ADH to DCIS or carcinoma or from DCIS to carcinoma) after surgical resection. In comparison, only eight of the 22 cases (36%) biopsied with an 11-gauge VAD were upgraded after surgical resection. The rate of upgrading of ADH to DCIS or invasive carcinoma after resection was 58% (7 of 12) when initial diagnosis was based on biopsy with a 14-gauge gun and 20% (1 of 5) when initial diagnosis was based on biopsy with an 11-gauge VAD. The upgrading rate of DCIS to invasive carcinoma was 50% (5/10) when initial diagnosis was based on biopsy with a 14-gauge automated gun versus 41% (7/17) when the initial diagnosis was based on biopsy with an 11-gauge VAD. However, significance between the groups was only foundfor lesions with a BI-RADS category of 4b (P=0.046). Rebiopsy was performed for 6% (33/563) of the 14-gauge gun biopsies and 4% (16 of 417) of the 11-gauge VAD. Malignancies were found after rebiopsy in a comparable percentage of lesions originally biopsied with a 14-gauge gun and those biopsied with an 11-gauge VAD (40% of 33 lesions and 31% of 16 lesions).

   The underestimation rate was significantly higher for lesions less than 20 mm than those greater than 21 mm (70% versus 34%, P=0.04) and increased with increasing BI-RADs score (88% for category 5, 50% for category 4a, 27% for category 4b, and 33% for category 3, P=0.04). Although not significantly different, the underestimation rate was 60% (6 of 10) for calcifications and 41% (14 of 34) for masses. 

   Biospecimens

   • Tissue - Breast

   Preservative Types

   • Formalin

   Diagnoses:

   • Neoplastic - Benign
   • Neoplastic - Carcinoma

   Platform:

   Analyte	Technology Platform
   Morphology	Light microscopy
   Morphology	H-and-E microscopy

   Pre-analytical Factors:

   Classification	Pre-analytical Factor	Value(s)
   Preaquisition	Prognostic factor	<20 mm lesion >21 mm lesion BI-RADS 3 BI-RADS 4a BI-RADS 4b BI-RADS 5 Calcification Mass
   Biospecimen Acquisition	Method of tissue acquisition	Vacuum assisted biopsy Surgical resection Core needle biopsy
   Biospecimen Acquisition	Needle gauge	14-gauge gun 11-gauge VAD

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