Can the radiologist accurately predict the adequacy of sampling when performing ultrasound-guided core biopsy of BI-RADS category 4 and 5 lesions detected on screening mammography?
OBJECTIVE
To investigate in mammography screening the correlation between the confidence level of the radiologist, in sampling BI-RADS assessment category 4 and 5 lesions using a single ultrasound-guided 14-gauge needle core biopsy, and the final histological diagnosis.


METHODS
In a prospective study, 389 consecutive ultrasound-guided 14-gauge needle core biopsies were performed on 131 BI-RADS assessment category 4 and 5 breast lesions in 126 women. On average, 3 passes were made through each lesion; for each pass, the radiologist rated confidence in adequacy of sampling at <50%, 50% to 90% or >90%. This was compared with the final histological diagnosis.


RESULTS
The radiologist was >90% confident in 293 biopsies; diagnostic results were confirmed at histology in 283 (97%). In 70 biopsies the radiologist was 50% to 90% confident; diagnostic results were confirmed in 60 (86%). Of 26 samples where confidence was <50%, 13 were diagnostic (50%) (p<0.0001).


CONCLUSIONS
If, at the time of ultrasound-guided needle core biopsy of BI-RADS assessment category 4 and 5 breast lesions, the radiologist is >90% confident that the lesion has been adequately sampled, a single pass is usually sufficient for diagnosis.
Doyle
J M
JM
Department of Radiology, St Vincent's University Hospital, Dublin 4, Ireland. jeanfagan@iol.ie
O'Doherty
A
A
Coffey
L
L
Pender
S
S
Hill
A
A
Quinn
C
C
D001291:Attitude of Health Personnel; D001707:Biopsy, Needle / Q000295:instrumentation / Q000379:methods*; D001943:Breast Neoplasms / Q000175:diagnosis*; D002278:Carcinoma in Situ / Q000175:diagnosis; D018270:Carcinoma, Ductal, Breast / Q000175:diagnosis; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000175:diagnosis; D016009:Chi-Square Distribution; D002983:Clinical Competence; D005260:Female; D006801:Humans; D008327:Mammography; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011871:Radiology; D016217:Ultrasonography, Mammary