Missed breast cancers at US-guided core needle biopsy: how to reduce them.
Ultrasonographically (US) guided core needle biopsy is currently recognized as a reliable alternative to surgical biopsy for the histopathologic diagnosis of breast lesions. However, despite advances in biopsy devices and techniques, false-negative diagnoses are unavoidable and may delay the diagnosis and treatment of breast cancer. The most common reasons for false-negative diagnosis are (a) technical or sampling errors, (b) failure to recognize or act on radiologic-histologic discordance, and (c) lack of imaging follow-up after a benign biopsy result. Technical difficulties (eg, poor lesion or needle visualization, deeply located lesions, dense fibrotic tissue) cause inaccurate sampling but can be reduced by using modified standard techniques. Radiologic-histologic correlation is also of critical importance in US-guided core needle biopsy. Radiologic-histologic discordance occurs when the histologic results do not provide a sufficient explanation for the imaging features and indicates that the lesion may not have been sampled adequately, so that repeat biopsy is warranted. Appropriate follow-up imaging is invaluable; even patients with concordant benign findings after US-guided core needle biopsy are directed to undergo follow-up imaging because there may be delays in the recognition of false-negative findings. Optimization of technique, radiologic-histologic correlation, and postbiopsy follow-up protocols are recommended to reduce the occurrence of false-negative diagnosis at US-guided core needle biopsy performed by radiologists.
Youk
Ji Hyun
JH
Department of Diagnostic Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seodaemun-ku, Shinchon-dong 134, Seoul 120-752, South Korea.
Kim
Eun-Kyung
EK
Kim
Min Jung
MJ
Lee
Ji Young
JY
Oh
Ki Keun
KK
D001707:Biopsy, Needle / Q000379:methods*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D003951:Diagnostic Errors / Q000517:prevention & control*; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011785:Quality Assurance, Health Care / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014463:Ultrasonography