Can US-guided vacuum-assisted biopsies be an alternative to diagnostic surgery in cases of non-diagnostic core needle biopsy?

Objective: To assess US-guided vacuum-assisted biopsies in the diagnosis of suspicious sonographic breast lesions after non-diagnostic core needle biopsies (CNB).

Methods: Retrospective study of 42 females with suspicious breast lesions at US. CNB previously performed were non-diagnostic. Because of the larger sample size, vacuum-assisted biopsies were performed, instead of surgical biopsy.

Results: Vacuum-assisted biopsies showed 32 benign lesions. Histologic examination of the CNB showed non-specific fibrous tissue in 43% of cases as opposed to 7.1% for vacuum-assisted biopsies. The latter provided a more specific diagnosis (mainly fibrocystic breast disease). From a total of 4 lesions that were suspicious at CNB, 3 were diagnosed as malignancies after vacuum-assisted biopsy and one case was a "borderline" lesion. Three additional malignant and three additional borderline lesions were diagnosed on vacuum-assisted biopsies. In 11 cases, surgical excision was performed, and all diagnoses from vacuum-assisted biopsies were confirmed at microscopy, except in one case where it was underestimated (ADH versus DCIS).

Conclusions: US-guided vacuum-assisted biopsy is a reliable technique. Because it provides more tissue than CNB, it can be an alternative to diagnostic surgery after non-diagnostic CNB. Indeed, it allows confirmation of the diagnosis and provides a more specific diagnosis of benign lesions. With regards to malignant and borderline lesions, it avoids the risk of false-negative CNB and overlooking carcinomas.