Analysis of US-Guided Core Needle Biopsy of Breast Lesions in a Tertiary Cancer Centre

Abstract Purpose Preoperative diagnosis of breast lesions is typically performed using ultrasound (US)-guided core needle biopsy (CNB), and this study analyses factors impacting its performance. Methods This study retrospectively analyzed CNBs conducted over 63 months at a tertiary cancer center to assess diagnostic accuracy (DA) and factors influencing biopsy success, including radiologists' experience, needle gauge size, number of cores, and strain elastography. Results Of 868 technically successful biopsies, 25 were diagnostically unsuccessful, yielding an overall diagnostic success rate of 97.1%. A statistically significant difference ( p  < 0.001) was observed between 14G and 18G needles, with diagnostic success improving from 94.4 to 99.8% using 14G needles. Combining Breast Imaging Reporting and Data System (BI-RADS) with elastography improved DA for benign lesions from 93.2 to 95.7% and for suspicious lesions (BI-RADS 4C/5) from 93.5 to 97.4%. In radio-pathologically discordant BI-RADS 4C/5 cases, malignancy was found in 17.5% ( n  = 7) upon surgical excision or clinical follow-up, highlighting the need for rebiopsy in discordant cases. The false-negative rate was 0.9%. Conclusion Overall, US-guided CNB demonstrated high DA, with sensitivity, specificity, and accuracy of 98.4, 100, and 98.8%, respectively—comparable to global standards. Implementing practice-enhancing measures, such as using 14G needles and ensuring that radiologists trained in breast imaging perform biopsies, can further improve technical and diagnostic success.