The Study Of The Clinical Value Of Ultrasound Guided Core-needle Biopsy (US-CNB) In The Diagnosis Of Breast Lesions Under Categories 4A To 4C

Objective: Breast cancer is one of the most common malignant tumors in the world,the incidence of breast cancer is second only to lung cancer in China.At the same time,breast cancer is the most common malignant tumor in women,and is one of the leading causes of cancer death.With the improvement of ultrasonic instrument and the improvement of the diagnostic level,breast ultrasound guided-core needle biopsy(US-CNB),with the support of ultrasound image,get the pathological examination of suspicious tissue,to provide the pathological basis for the diagnosis of breast tumor.BI-RADS grade 1~3 is considered benign,BI-RADS grade 5~6 is basically considered malignant.This study aims to evaluate the clinical value of ultrasound-guided core-needle biopsy(US-CNB)in the diagnosis of breast lesions under categories 4A to 4C of the second edition of the Breast Imaging Reporting and Data System(BI-RADS)ultrasound lexicon,and the main influencing factors of false negative and the influence of different molecular typing on US-CNB diagnosis.Patients and methods: The pathological characteristics of 355 patients with breast masses who underwent US-CNB in the Tianjin Medical University Cancer Institute and Hospital from March 2015 to October 2015 were retrospectively analyzed.Each patient was subjected to postoperative pathological examination to confirm diagnosis.The effects of different molecular typing on US-CNB diagnosis were summarized.Results: According to the US-CNB results,of the 355 patients,235 were diagnosed with breast cancer(4A:10cases,4B:94cases,4C:131cases),and 120 had benign lesions(4A:29cases,4B:60cases,4C:31cases).Through postoperative pathological examination,235 of patients diagnosed with breast cancer were confirmed to have breast cancer,41 of the patients with benign lesions were confirmed to have breast cancer.Postoperative pathological results: 276 of patients were diagnosed with breast cancer(4A:16cases,4B: 114 cases,4C: 146cases),79 of patients were diagnosed with benign lesions(4A:23cases,4B: 40 cases,4C: 16cases).The specificity of the US-CNB was 100% in all the categories of breast masses.The sensibilities of breast masses under BI-RADS categories 4A,4B,and 4C were 62.50%,82.46%,and 89.73%,respectively.The accuracies of the US-CNB in 4A,4B,and 4C were 84.62%,87.01%,and 90.74%,correspondingly.Of the 41 patients with false-negative results,14 had intraductal carcinoma,5 had intraductal papillary carcinoma,3 had mucinous carcinoma,and 19 had invasive ductal carcinoma.The specificity of US-CNB in the diagnosis of breast cancer was 100% in patients with Luminal A,Luminal B,Triple negative and Her-2 overexpression.The sensibilities of breast masses under Luminal A,Luminal B,negative and Her-2 overexpression were 86.09%,84.34%,83.33%,86.11%.False negative rate were 13.91%,15.66%,16.67%,13.89%.Conclusion: US-CNB is a safe,reliable,and accurate early diagnostic method for breast masses under the 4Band 4C categories.However,the sensibility of US-CNB was extremely low in patients with breast masses under the 4A category.Thus,final diagnosis should be accomplished by combining US-CNB with mammography,MRI et al.testing methods.Meanwhile,by analyzing the cause of false negative rate,US-CNB is not recommended for patients with intraductal papillary neoplasms diagnosed through ultrasonography.At the same time,the results of this study showed that there was no difference in the false negative rate and sensitivity of US-CNB in breast cancer through molecular classification.Molecular classification is not the reason of effect for the accuracy of US-CNB.