Ultrasound-Guided Needle Biopsy of Suspected Microcalcifications in the Breast.

Background: Sonography plays an important role in characterizing breast masses and in guiding needle core biopsies and wire localizations of suspicious sonographis abnormalities. Objective: The aim of this study was to show the possibilities of high frequency ultrasound devices in the presentation of microcalcifications of the breast, and the use of these possibilities in performing needle biopsy under ultrasound control. Methods: This was a retrospective study conducted from May 2017 to December 2020 on 32 women, 29-86 years of age using mammograms and ultrasound to show suspected microcalcifications (radiological findings of BI RADS 4B and 4C), and needle biopsy led by ultrasound that confirmed the diagnosis of breast cancer. Patients with suspected microcalcifications on mammography that had previously had the diagnosis of breast cancer confirmed in the same or contralateral breast were excluded from the study. Histology results from each core biopsy and surgical excision were reviewed. The positive predictive values of sonography and mammography for this population were calculated, and the sensitivity, specificity, and negative predictive value of sonography were determined. For analysis of the agreement of ultrasound findings with mammography the McNemar x2-test for dependent samples was used. Results: The sensitivity of mammography in the detection of microcalcifications in this study was 100%. The sensitivity of the ultrasound apparatus with a high frequency probe in the detection of microcalcifications after mammography examination in this study was 87.55%, while the specificity was 42.85%. Conclusion: Ultrasonic devices with high-frequency probes enable the display of accumulations of microcalcifications previously verified by mammography, and thus enable the performance of needle biopsy of suspected microcalcifications under ultrasonic control. An alternative is the much more complicated and significantly more expensive stereotactic biopsy under the control of mammography.

Comparison of preoperative diagnostic accuracy of fine needle aspiration and core needle biopsy in parotid gland neoplasms.

BACKGROUND: Fine needle aspiration (FNA) and core needle biopsy (CNB) are two commonly used approaches for the diagnosis of suspected neoplastic parotid gland lesions. We aimed to compare the diagnostic efficiency of FNA and CNB performed with ultrasound guidance preoperatively for the diagnosis of parotid neoplasms. METHODS: We retrospectively analysed the preoperative specimens of 113 patients (66 FNA, 47 CNB) who underwent surgical excision at our institute between 2014 and 2017. Patient selection was based on lesion type and dimension, preliminary and final pathology, imaging characteristics, clinical course, and treatment data for accurate statistical analysis. The final diagnosis was based on surgery in all of the patients. We compared the diagnostic accuracy of FNA and CNB regarding the correct tissue-specific diagnosis of benign and malignant tumours. The recurrence and complication rates were analysed to determine the safety of each technique. RESULTS: Among the 113 patients, the average follow-up period was 65.4 (50-88) months. Seventy-one patients (62.8%) were males, and the median age was 50 years. The most common type of surgery was superficial parotidectomy (83.2%), and the median tumour size was 30.0 mm. Pleomorphic adenoma was the most frequent neoplasm. The diagnostic rates of preoperative pathological evaluation of FNA and CNB samples were 68.2% and 91.5%, respectively. The sensitivity, specificity, and positive predictive value of FNA for detecting malignant lesions were 40, 100, and 100%, respectively, and those of CNB were 100, 100, and 100%, respectively. Only one complication occurred (haematoma) in the biopsy area after CNB. No recurrences were seen after CNB and FNA during the follow-up period. CONCLUSION: Our findings suggest that the diagnostic ability, sensitivity, and specificity of CNB are excellent compared with those of FNA. The only disadvantage of CNB is the need for experienced staff and good-quality equipment. The complication rates of each technique are very low, and the risk of tumour tract seeding is controversial. CNB should be considered the technique of choice when a nodule is detected in the parotid glands.

Ultrasound-Guided Biopsies: Medium and Large Joints.

Ultrasound-guided needle synovial biopsies are useful for clinical practice and research in rheumatology. With the emergence of personalized medicine for the treatment of inflammatory rheumatic diseases, it is predicted that this technique will be increasingly used in the near future. Standardized characterization of the technical aspects of ultrasound-guided needle synovial biopsies is needed in order to produce solid evidence on the safety and effectiveness of the technique.

Ultrasound-guided needle biopsy of large thyroid nodules: Core needle biopsy yields more reliable results than fine needle aspiration.

PURPOSE: The objective of this study was to compare the false negative rate, sensitivity and false positive rate of ultrasound (US)-guided fine needle aspiration (FNA) with those of US-guided core needle biopsy (CNB) for large thyroid nodules ≥2.0 cm, which reportedly have an increased risk of thyroid malignancy. METHODS: We retrospectively studied surgically confirmed thyroid nodules that had preoperative US-guided FNA or CNB between March 2005 and December 2013. We reviewed nodule size, sonographic features, cytohistologic results, and final surgical pathology. We assessed false negative rates, sensitivity, and false positive rates by biopsy method and nodule size for diagnosis of thyroid malignancy. We assessed complications for procedures. RESULTS: US-guided CNB showed better diagnostic performance, in terms of lower false negative rates and greater sensitivity, than US-guided FNA in large thyroid nodules. There was no significant difference in false positive rate according to biopsy methods in large thyroid nodules. The false negative rates of large thyroid nodules (≥2.0 cm) were higher than those of small nodules (<2.0 cm). There were no major complications, and no significant differences in complication according to biopsy methods. CONCLUSION: US-guided CNB improved the false negative rate and sensitivity for large nodules. Therefore, US-guided CNB can be considered a useful diagnostic method for large thyroid nodules that might reduce the risk of unnecessary diagnostic surgery.

Supplemental ultrasound screening in patients with a history of lobular neoplasia.

To investigate the role of ultrasound (US) screening as an adjunct to annual mammography (M) in breast cancer detection in women with a history of lobular neoplasia (LN) diagnosed following core needle or excisional biopsy. A retrospective review of our database was performed between 11/2006 and 11/2011 to identify patients diagnosed with LN, and underwent annual screening. Patients with a lifetime risk >20% per risk modeling were excluded. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and cancer detection rate (CDR) of each screening test were identified. Cancer type and detection modality were recorded. A total of 100 patients who had M and/or US screening were included. Mean patient age was 54.7 years (range 33-83). All 100 patients underwent a mean of 3.9 rounds of screening M and 93 (93%) received US screening (mean 3.3 rounds). Of 93 patients who received both M and US screening, 12 (13%) were diagnosed with breast cancer. Mammographic CDR was 4%. Incremental US CDR was 6.5%. The sensitivity, specificity, and NPV for M screening alone was 33% (10%, 65%), 77% (67%, 85%), and 89% (80%, 95%), respectively. US and mammography screening had a combined sensitivity: 83% (52%, 98%), Specificity: 72% (62%, 81%), NPV: 97% (89%, 100%). Supplemental US screening resulted in a significant increase in sensitivity, yielding 6.5% incremental CDR in this high-risk patient subgroup that does not fulfill ACS high-risk MRI screening criteria.

Fine-needle aspiration with selective use of core needle biopsy of major salivary gland tumors.

OBJECTIVES: Preferential use of fine-needle aspiration (FNA) versus core needle biopsy (CNB) for distinguishing benign from malignant major salivary gland tumors is highly debated. The main disadvantage of FNA is lower sensitivity, whereas arguments against CNB include use of a larger bore needle and greater risk of complications. The aim of this study is to evaluate our experience performing ultrasound-guided (UG) FNA with selective use of CNB based on preliminary cytopathology, and to determine whether our preoperative diagnostic approach is more sensitive and specific than FNA alone-and at least as sensitive and specific as CNB alone. STUDY DESIGN: Retrospective review of UG needle biopsy sampling of lesions arising in or around parotid and submandibular glands. METHODS: Ultrasounds of 141 needle biopsies were identified. Patient/lesion/needle biopsy characteristics, preliminary cytopathology, final pathology, imaging studies, and subsequent clinical course and treatment were documented. RESULTS: Needle biopsies performed according to our protocol provided results that guided clinical decision making in 125 of 135 cases, 92.6% (95% confidence interval [CI], 86.8%-96.4%) of the time. Using 41 cases that had histologic verification, sensitivity was 100% (95% CI, 79.6%-100%), and specificity was 92.3% (95% CI, 75.9%-97.9%) for detecting malignancy. We definitively characterized 120 lesions as benign (84) or malignant (36). CONCLUSION: Preoperative needle biopsy diagnoses allowed clinical management to progress 92.6% of the time. The protocol of FNA with selective use of CNB may potentially reduce patient exposure to risks associated with CNB without the tradeoff of lower sensitivity seen with FNA. LEVEL OF EVIDENCE: 4. Laryngoscope, 127:2522-2527, 2017.

Sonography and Sonographically Guided Needle Biopsy of Internal Mammary Nodes in Staging of Patients With Breast Cancer.

OBJECTIVE: The purpose of this study was to identify the prevalence of occult nodal metastases on routine ultrasound examination of internal mammary (IM) nodal basins in patients with breast cancer. MATERIALS AND METHODS: Patients with primary breast cancer (n = 595) underwent breast ultrasound evaluation between September 1, 2011, and April 1, 2012. For all patients, ultrasound examination included a survey of the axillary, infraclavicular, IM, and supraclavicular nodal basins. Patient demographics, breast cancer histopathologic type, and grade, size, location, and presence of metastatic nodes in regional nodal basins were recorded. Fisher exact test and Wilcoxon rank test were used for statistical analysis. RESULTS: Fifty-eight of 595 (10%) patients had positive IM ultrasound finding, with eight (1.3%) patients having isolated IM involvement. Patients with positive IM ultrasound findings were statistically significantly younger than those without such findings (median age, 42 vs 57 years; p < 0.0001). Of the 58 patients with positive IM ultrasound, 29 (50%) underwent ultrasound-guided needle biopsy, which confirmed malignancy in 26 of 29 (90%) patients. Nonlateral (p < 0.001) grade 3 (p < 0.001) tumors larger than 5 cm (p < 0.0006) with the estrogen receptor-negative HER2/neu-negative subtype (p < 0.001) associated with axillary, infraclavicular, or supraclavicular metastases (p < 0.001) were more likely to be associated with positive IM ultrasound findings. IM ultrasound resulted in an N status change for 46 of 595 (8%) patients and of the overall clinical stage for 38 (6.4%) patients. CONCLUSION: IM ultrasound and ultrasound-guided fine-needle aspiration biopsy are feasible, sensitive, and specific. Application of IM ultrasound and ultrasound-guided needle biopsy in a selected subpopulation of young patients with medial or central estrogen receptor-negative HER2/neu-negative breast cancer may result in a change in clinical stage and modify the treatment plan.

Staging the axilla in women with breast cancer: the utility of preoperative ultrasound-guided needle biopsy.

Preoperative staging of the axilla in women with invasive breast cancer using ultrasound-guided needle biopsy (UNB) identifies approximately 50% of patients with axillary nodal metastases prior to surgical intervention. Although moderately sensitive, it is a highly specific staging strategy that is rarely falsely-positive, hence a positive UNB allows patients to be triaged to axillary lymph-node dissection (ALND) avoiding potentially unnecessary sentinel node biopsy (SNB). In this review, we extend our previous work through an updated literature search, focusing on studies that report data on UNB utility. Based on data for 10,934 breast cancer patients, sourced from 35 studies, a positive UNB allowed triage of 1,745 cases (simple proportion 16%) to axillary surgical treatment: the utility of UNB was a median 19.8% [interquartile range (IQR) 11.6%-26.7%] across these studies. We also modelled data from a subgroup of studies, and estimated that amongst patients with metastases to axillary nodes, the odds ratio (OR) for high nodal disease burden for a positive UNB versus a negative UNB was 4.38 [95% confidence interval (95% CI): 3.13, 6.13], P<0.001. From this model, the estimated proportion with high nodal disease burden was 58.9% (95% CI: 50.2%, 67.0%) for a positive UNB, whereas the estimated proportion with high nodal disease burden was 24.6% (95% CI: 17.7%, 33.2%) if UNB was negative. Overall, axillary UNB has good clinical utility and a positive UNB can effectively triage to ALND. However, the evolving landscape of axillary surgical treatment means that UNB will have relatively less utility where surgeons have modified their practice to omission of ALND for minimal nodal metastatic disease.

Local and regional staging of invasive breast cancer with sonography: 25 years of practice at MD Anderson Cancer Center.

At The University of Texas MD Anderson Cancer Center, we have used sonography (US) extensively for more than 2 decades to refine the local and regional staging of invasive breast cancer. Although magnetic resonance imaging is superior to all other imaging modalities in the measurement of the primary tumor and detection of additional foci of malignancy, in our experience US has shown sufficient accuracy in clinical practice to stage most invasive breast cancers. The exceptions are ill-defined tumors such as invasive lobular cancers and tumors in breasts containing extensive diffuse benign disease. An advantage of US is that multifocality or multicentricity can be confirmed via US-guided fine-needle aspiration within 15 minutes and the information shared immediately with the patient and the breast surgeon or medical oncologist. US has also proved indispensable in the evaluation of lymphatic spread because it can evaluate more nodal basins (e.g., the supraclavicular fossa and low neck) than magnetic resonance imaging can and because it can guide needle biopsy to confirm the status of any indeterminate node (including internal mammary nodes) within minutes.

The role of ultrasound-guided needle biopsy in the diagnosis of soft-tissue tumors.

Soft-tissue tumors are not very common, but their diagnosis can be very difficult. In the final analysis, their diagnosis requires a biopsy, which must furnish a sufficient amount of material to allow a reliable histological diagnosis. The authors evaluated the diagnostic efficacy of ultrasound-guided needle biopsy in the diagnosis of soft-tissue tumors of the musculoskeletal system. The aim of the study was to optimize the biopsy procedure, with particular emphasis on the choice of the biopsy needle (large-gauge manual versus semiautomatic) based on the characteristics of the neoplastic mass (consistency, depth, size, location). The results of the study showed that appropriate needle selection significantly reduced the frequency of biopsies that were insufficient for histological diagnosis. The method proved to be highly reliable for diagnosis of soft-tissue tumors but strongly related to the proper selection of the needle to be used.