• Published
  • Issue
    Vol: 28 Issue: 01, 2024


  • Dr. Anita Sharma 1, *Dr. Satish Parihar 2, Dr. Rajat Gupta 3

Keywords: Breast biopsy, breast cancer, ultrasound guided, freehand core needle biopsy.

Background: The most common malignancy diagnosed in women worldwide is carcinoma breast, accounting for more than 1 in 10 new cancer diagnoses each year. Nowadays, percutaneous core needle biopsy is a reliable alternative to surgical biopsy as it provides adequate sample for histological analysis. Aim: To verify the improved diagnostic accuracy of ultrasound guided over freehand core needle biopsy in palpable breast masses and to determine the factors associated with false negative freehand biopsies in palpable breast masses. Methods: Prospective randomized study was conducted in Post graduate department of General Surgery, Pathology and Radiodiagnosis, Government Medical College Jammu from November 2019 to October 2020. A total of 40 women presenting to the department of general surgery meeting the inclusion criteria were included in the study. Patients were equally randomized into freehand and ultrasound guided core needle biopsy arms, 20 patients each, with the help of computer generated randomization application. The study protocol was approved by the institutional ethical committee of the Government Medical College Jammu. A detailed history was recorded and complete physical examination was done. All biopsies were performed under local anaesthesia using 14 gauge automated core biopsy needles. Ultrasound by a single operator was used for image guidance. Results: Mean value of age (years) of study subjects was 45.38 ± 10.9 with median (25th-75th percentile) of 45(38-51). In 52.50% and 45% of patients, left and right side was involved respectively. Both sides were involved in only 1 out of 40 patients (2.50%). Concordance was seen in majority of patients in Freehand and USG guided biopsy; 75% in freehand and 95% in USG guided and discordance was seen in 25% of patients in freehand and 5% of patients in USG guided with no significant difference in them (p value=0.182). Core needle biopsy (CNB) HPE reported malignancy in majority of patients in Freehand and USG; 50% in freehand and 55% in USG. Benign pathology was found in 40% of patients in freehand and 45% of patients in USG. CNB HPE report was inconclusive in very few patients; 10% of patients in freehand and 0% of patients in USG. Sensitivity (95% CI) was comparable in free hand and USG (83.33% vs 91.67% respectively, p value = 0.774). Diagnostic accuracy was comparable in free hand and USG (88.89% vs 95% respectively, p value = 0.924). Conclusion: We conclude that whenever available, USG guided core needle biopsy should always be preferred over freehand biopsies to maximize the diagnostic accuracy and obviate the need for repeat biopsies. However, in the absence of imaging modalities, only those breast mass biopsies should be done by freehand which are unlikely to be missed.