title: Diagnostic accuracy for different strategies of image-guided breast intervention in cases of nonpalpable breast lesions.
abstract: To find out whether ultrasound-guided fine-needle aspiration (FNA) and ultrasound and stereotactic-guided large core needle biopsy (LCNB) are reliable alternatives to needle-localised open breast biopsy (NLBB) in daily practice, we performed a retrospective study and evaluated the validity of these methods. In all, 718 women with 749 nonpalpable breast lesions from three Dutch Hospitals were included, and the validity of the various methods for diagnosis was assessed. This was carried out according to a method described by Burbank and Parker for evaluating the quality of an image-guided breast intervention. We compared our results with the outcome of the COBRA study. Overall, all diagnostic strategies (NLBB, FNA, LCNB ultrasound and stereotactic guided) show comparable agreement rates. However, the miss rates differ: 2% for NLBB, 3% for COBRA (LCNB in study setting), 5% for FNA and 8-12% for LCNB in practice. Fine-needle aspiration was nonconclusive in 29%, and shows an overestimation for DCIS in 9%. The DCIS underestimate rate in NLBB was 8%. For the assessment of lesions consisting of microcalcifications only and to exclude malignancy in all other lesions, a 14-gauge needle should be used. Ultrasound-guided intervention can be performed in a large percentage of nonpalpable lesions. Lesions consisting only of microcalcifications on mammography need special attention.
authors.affiliation: Department of Radiology, Martini Hospital, Locatie van Swieten, PO Box 30033, 9700 RM Groningen, The Netherlands. R.Pijnappel@mzh.nl
authors.forename: R M
authors.initials: RM
authors.lastname: Pijnappel
authors.forename: M
authors.initials: M
authors.lastname: van den Donk
authors.forename: R
authors.initials: R
authors.lastname: Holland
authors.forename: W P Th M
authors.initials: WP
authors.lastname: Mali
authors.forename: J L
authors.initials: JL
authors.lastname: Peterse
authors.forename: J H C L
authors.initials: JH
authors.lastname: Hendriks
authors.forename: P H M
authors.initials: PH
authors.lastname: Peeters
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle / Q000379:methods; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013238:Stereotaxic Techniques; D018084:Ultrasonography, Interventional