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(Radiology. 2001;218:866-872.)
© RSNA, 2001

Breast Imaging

Stereotactic Core-Needle Breast Biopsy: A Multi-institutional Prospective Trial1

R. James Brenner, MD, Lawrence W. Bassett, MD, Laurie L. Fajardo, MD, D. David Dershaw, MD, W. Phil Evans, III, MD, Rebecca Hunt, MD, Carol Lee, MD, Irena Tocino, MD, Paul Fisher, MD, Marie McCombs, MD, Valerie P. Jackson, MD, Stephen A. Feig, MD, Ellen B. Mendelson, MD, Frederick R. Margolin, MD, Richard Bird, BA and James Sayre, PhD

1 From the Joyce Eisenberg Keefer Breast Center, John Wayne Cancer Institute, St Johns Health Center, 1328 22nd St, Santa Monica, CA 90404 (R.J.B.). Affiliations for all other authors are listed at the end of this article. Received January 26, 2000; revision requested March 3; final revision received July 19; accepted August 28. Address correspondence to R.J.B. (e-mail: James.Brenner@stjohns.org).

PURPOSE: To assess the accuracy of stereotactic core-needle biopsy (CNB) of nonpalpable breast lesions within the context of clinically important parameters of anticipated tissue-sampling error and concordance with mammographic findings.

MATERIALS AND METHODS: CNB was performed in 1,003 patients, with results validated at surgery or clinical and mammographic follow-up. Mammographic findings were scored according to the American College of Radiology Breast Imaging Reporting and Data System with a similar correlative scale for histopathologic samples obtained at either CNB or surgery. Agreement of CNB findings with surgical findings or evidence of no change during clinical and mammographic follow-up (median, 24 months) for benign lesions was used to determine results. Three forms of diagnostic discrimination measures (strict, working [strict conditioned by tissue sampling error], applied [working conditioned by concordance of imaging and CNB findings) were used to evaluate the correlation of CNB, surgical, and follow-up results.

RESULTS: Strict, working, and applied sensitivities were 91% ± 1.9; 92% ± 1.8, and 98% ± 0.9, respectively; strict, working, and applied specificities were 100%, 98% ± 0.8, and 73% ± 0.9; strict, working, and applied accuracies were 97%, 96%, and 79%.

CONCLUSION: Percutaneous stereotactic CNB is an accurate method to establish a histopathologic diagnosis of nonpalpable breast lesions. Accuracy increases when additional surgery is performed for lesions with anticipated sampling error or when CNB findings are discordant with mammographic findings. An understanding of the interrelationship among these parameters is necessary to properly assess results.

Index terms: Breast, biopsy, 00.1261, 00.1267 • Breast neoplasms, diagnosis, 00.31, 00.32 • Breast radiography, utilization, 00.11




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