CEUS-Guided Core Needle Biopsy Reduces Underestimation in Breast Lesions: A Prospective Randomized Study.
Xin Liu, Yuwei Wang, Yingxuan Tu et al.
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In 30 seconds
This single-centre prospective randomised controlled trial compared contrast-enhanced ultrasound (CEUS)-guided with conventional ultrasound-guided core needle biopsy in 340 patients undergoing breast lesion biopsy. Against surgical pathology, diagnostic accuracy was higher with CEUS guidance (93.5% vs. 82.4%, P=0.02). CEUS guidance was also associated with lower overall underestimation and false-negative rates. Subgroup analyses found higher accuracy in premenopausal patients and in lesions with microcalcifications or heterogeneous internal echoes; molecular subtype concordance in invasive cancer was also higher with CEUS.
Key findings
- Diagnostic accuracy was 93.5% with CEUS-guided biopsy versus 82.4% with conventional guidance (P=0.02).
- Overall underestimation rates were 40.7% vs. 73.2% (P=0.007), and false-negative rates were 3.1% vs. 13.9% (P=0.002), respectively.
- In invasive cancer, molecular subtype concordance with surgical pathology was 85.7% with CEUS versus 74.8% with conventional guidance (P=0.043).
- CEUS-guided biopsy had higher accuracy in premenopausal patients and lesions with microcalcifications or heterogeneous internal echoes (all P<0.05).
Why it matters
Biopsy underestimation and false-negative results can leave malignancy unrecognised before definitive pathology. In this randomised comparison, CEUS guidance improved diagnostic accuracy and reduced both outcomes, while also improving molecular subtype concordance in invasive cancer. These findings suggest that guidance technique may affect the reliability of tissue diagnosis and information used in subsequent clinical decision-making.
What to keep in mind
The trial was conducted at a single centre, which may limit how readily the findings generalise to other settings.