Audit of ultrasound-guided breast biopsy/fine needle aspiration, in response to increasing demand on service provision

Aims

To evaluate usage of ultrasound biopsy appointments. To elicit factors that might influence numbers referred for biopsy.

Methods

A retrospective review of all patients attending for breast biopsy/FNA over a 6-month period. Ultrasounds were graded U2–U5 and were compared with pathology/cytology outcomes. The positive predictive value (PPV) for the ultrasound grade was calculated. Other factors such as age, specific ultrasound features, correlation with mammographic findings and size were obtained for U3 lesions.

Results

There were 199 biopsy appointments in 179 women aged 21–93 years. Sixteen had no histopathology/cytology – either the lesion resolved or a simple cyst aspirated. Of the remaining women, 51% were graded U3, 9% U4 and 11% U5. The PPV for U3 lesions was 13%. U4 and U5 PPVs were 69% and 95%, respectively, comparable with published standards. Forty-eight cases were U2, mainly for completion of triple assessment.

Conclusion

U2 and U3 lesions form the majority of the biopsy workload. The PPV for U3 lesions is lower than the expected standard. Correlation with additional imaging and demographic factors may allow for downgrading of some benign lesions previously designated U3, with concomitant freeing of capacity.