Value Of Ultrasound-guided Core Needle Biopsy In Diagnosing Breast Cancer

Purpose:Nowadays,Ultrasound-guided biopsy has been widely used in clinical as it is a safe,effective and simple pathological diagnosis technology.For suspicious breast lesions found in conventional ultrasound,ultrasound-guided biopsy can provide pathological diagnosis before surgery.Previous studies have indicated that ultrasound-guided biopsy had a higher accuracy,however,one critical issue is that limited sample specimen could lead to underestimation.Precancerous lesions of breast cancer included breast ductal carcinoma in situ,lobular carcinoma in situ and atypical hyperplasia,and they have certain degree of abnormal or active tissue in morphology,leading difficult to diagnose in biopsy.Therefore,this study aimed to explore the value of ultrasound-guided biopsy in diagnosing breast neoplasm.After comparing biopsy pathology with postoperative pathology(or follow-up results),further study was worked on exploring the accuracy of ultrasound-guided biopsy in diagnosing precancerous lesions of breast cancer and the ultrasound indication of underestimation.Methods:605 cases from Jan 2012 to Dec 2015 were collected.Median follow-up time was 31 months.All patients in our hospital before biopsy underwent conventional ultrasound,and sonographic findings of breast lesions were recorded briefly.According to biopsy pathological results,surgery was recommended for malignant or suspicious lesions,and follow-up was recommended for benign lesions.Once follow-up patients appeared malignant performance,surgery were made,otherwise,follow-up patients kept biopsy pathological diagnosis.Compared the biopsy pathological results with postoperative pathology(or follow-up results),the sensitivity,specificity,accuracy,positive predictive value and negative predictive value of ultrasound-guided biopsy were calculated.For patients with precancerous lesions of breast cancer,they were divided into according group and upgrading group according to postoperative pathology(or follow-up results).Compared the differences between two groups in the sonographic findings such as size,margin,shape,calcification,posterior acoustic features,blood flow and abnormal axillary lymph nodes,and analyzed sonographic findings that may indicate underestimation.Chi-square test were used for count data and p< 0.05 was considered statistically significant.Results:1.Results of ultrasound-guided biopsy:Among the 605 lesions,the pathological results from ultrasound-guided biopsy were specific benign lesions in 331 cases(54.7%),malignant lesions in 229 cases(37.9%),precancerous lesions of breast cancer in 42 cases(6.9%),and 3 cases(0.5%)were failed to diagnose because of inadequate specimens.2.Comparison between biopsy pathology and surgical pathology(or follow-up results): For patients undergoing surgery,12 cases appeared underestimation.For follow-up patients,1 patient had given surgical resection because of the lesions appeared malignant performance and the surgical pathology confirmed underestimation.Finally,of 602 cases of breast lesions,patients with benign lesions in 328 cases(54.5%),malignant lesions in 240 cases(39.9%),precancerous lesions in 34 cases(5.6%).This study found out the sensitivity,specificity and accuracy of ultrasound-guided biopsy was 98.9%,100% and 97.8%.3.The accuracy of ultrasound-guided biopsy in diagnosing precancerous lesions:Of 42 cases of precancerous lesions found in biopsy,atypical hyperplasia were in 24 cases and of them 8 cases were confirmed to be carcinoma in situ,3 cases were were confirmed to be invasive carcinoma after surgery,the underestimation rate was 45.8%;of 18 cases of carcinoma in situ,7 cases were upgrading to invasive carcinoma,the underestimation rate was 38.9%.Because of the different clinical treatment,precancerous lesions were divided into according group(32 cases)and upgrading group(10 cases)according to whether invasive component were found in surgical pathology,the overall underestimation rate was 23.8%.4.Sonographic indication for underestimation: Compared the sonographic characteristics between according group and upgrading group,calcification(9/10),posterior acoustic attenuation(7/10),blood flow grade?2(7/10),abnormal axillary lymph nodes(4/10)were more common in upgrading group than according group(P < 0.001,0.003,0.027,0.001).Conclusion:1.Ultrasound-guided biopsy had high sensitivity,specificity and accuracy in diagnosing breast neoplasms.2.Ultrasound-guided biopsy might exist underestimation in diagnosing precancerous lesions of breast cancer.3.For precancerous lesions with malignant sonographic signs(such as calcification,posterior acoustic attenuation,abundant blood flow and abnormal axillary lymph nodes),patients were recommended to re-biopsy or open surgery to comfirm again.