title: Image guided versus palpation guided core needle biopsy of palpable breast masses: a prospective study.
abstract: OBJECTIVE
  Biopsy of palpable breast masses can be performed manually by palpation guidance or under imaging guidance. Based on retrospective studies, image guided biopsy is considered more accurate than palpation guided breast biopsy; however, these techniques have not been compared prospectively. We conducted this prospective study to verify the superiority and determine the size of beneficial effect of image guided biopsy over palpation guided biopsy.
  
  
  METHODS
  Over a period of 18 months, 36 patients each with palpable breast masses were randomized into palpation guided and image guided breast biopsy arms. Ultrasound was used for image guidance in 33 patients and mammographic (stereotactic) guidance in three patients. All biopsies were performed using 14 gauge automated core biopsy needles. Inconclusive, suspicious or imaging-histologic discordant biopsies were repeated.
  
  
  RESULTS
  Malignancy was found in 30 of 36 women in palpation guided biopsy arm and 27 of 36 women in image guided biopsy arm. Palpation guided biopsy had sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 46.7, 100, 100, 27.3 per cent, respectively, for diagnosing breast cancer. Nineteen of 36 women (52.8%) required repeat biopsy because of inadequate samples (7 of 19), suspicious findings (2 of 19) or imaging-histologic discordance (10 of 19). On repeat biopsy, malignancy was found in all cases of imaging-histologic discordance. Image guided biopsy had 96.3 per cent sensitivity and 100 per cent specificity. There was no case of inadequate sample or imaging-histologic discordance with image guided biopsy.
  
  
  CONCLUSIONS
  Our results showed that in palpable breast masses, image guided biopsy was superior to palpation guided biopsy in terms of sensitivity, false negative rate and repeat biopsy rates.
authors.affiliation: Department of Radio-diagnosis, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Smriti
authors.initials: S
authors.lastname: Hari
authors.affiliation: Department of Radio-diagnosis, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Swati
authors.initials: S
authors.lastname: Kumari
authors.affiliation: Department of Surgery, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Anurag
authors.initials: A
authors.lastname: Srivastava
authors.affiliation: Department of Radio-diagnosis, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Thulkar
authors.affiliation: Department of Pathology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Mathur
authors.affiliation: Department of Radio-diagnosis, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Prasad Thotton
authors.initials: PT
authors.lastname: Veedu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D062005:Biopsy, Large-Core Needle; D001940:Breast / Q000000981:diagnostic imaging / Q000473:pathology; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy; D008327:Mammography; D008875:Middle Aged; D010173:Palpation