Kevin Jay Kirshenbaum MD, Abstract Co-Author: Nothing to Disclose

Margaret M. Dickerson DO, Abstract Co-Author: Nothing to Disclose

Karen Hou MD, Presenter: Nothing to Disclose

Evaluate the diagnostic yield of each breast biopsy specimen to reassess the minimum number of specimens required to achieve an accurate diagnosis compared to the standard acquisition of five specimens.

A total of 121 consecutive breast mass biopsies were performed using a 14-gauge automated core biopsy needle under ultrasound guidance. Five specimens were obtained from each mass and placed in separate containers in the order of acquisition. Each specimen was evaluated by a pathologist in the order it was obtained and labeled diagnostic or non-diagnostic. During the biopsy procedure, the radiologist indicated after which number biopsy he was confident that an adequate diagnostic specimen had been obtained. This was based upon real-time visualization of the needle passing through the lesion and whether the specimen sank or floated in formalin. These observations were compared with the actual pathologic diagnostic yield according to specimen number.

41 lesions (34%) were malignant, 2 lesions (2%) were atypical, and 78 lesions (64%) were benign. Histology indicating diagnosis was obtained after the first specimen in 100 (82%) lesions, the second specimen in 107 (88%) lesions, the third specimen in 119 (98%) lesions, the fourth specimen in 120 (99%) lesions, and the fifth specimen in 121 (100%) lesions. Of the malignant lesions, a positive diagnosis was made in 91% after the first biopsy, 95% after the second biopsy, and 100% by the third biopsy. Eight (6.6%) cases showed discrepancy between the radiologist's confidence of diagnosis and the eventual pathologic diagnosis. Of these cases, six lesions were benign and two were malignant.

Diagnostic accuracy of 98.3% can be achieved after obtaining three biopsy specimens with ultrasound guided 14-gauge core breast biopsy.

Kirshenbaum, K, Dickerson, M, Hou, K, Reassessing Specimen Number and Diagnostic Accuracy of Ultrasound-guided Breast Core Biopsy.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4404913.html