Evaluation of the Diagnostic Accuracy of Ultrasound-Guided Biopsy versus Surgical Biopsy for Breast Cancer, Using Histopathology as the Gold Standard

Abstract

Breast cancer is the most common cancer among women worldwide and a leading cause of cancer death. Ultrasound-guided core needle biopsy (US-CNB) is a minimally invasive method for evaluating suspicious breast masses. This study aimed to evaluate the diagnostic accuracy of US-CNB compared with surgical biopsy, using histopathology as the gold standard. In this retrospective cross-sectional study at the National Cancer Institute, Misurata, Libya, the records of 137 women biopsied between January 2024 and May 2025 were reviewed, and 65 cases with complete data for both 14-gauge US-CNB and surgical biopsy were included (mean age 49.8 ± 11.1 years; range 26–85). Diagnostic performance was assessed using the chi-square test, sensitivity, specificity, predictive values, accuracy, and the Kappa coefficient. For malignancy detection, US-CNB achieved a sensitivity and positive predictive value of 100%, with an overall accuracy of 98.5% (Kappa = 1.00). For histological tumor typing, sensitivity and positive predictive value were 95.4% (Kappa = 0.94). For sample adequacy, sensitivity was 100%, specificity 80%, and efficiency 98.3% (Kappa = 0.88). For tumor grading, accuracy ranged from 90.3% to 93.5%, with moderate overall agreement (Kappa = 0.56). No statistically significant difference was found between the two methods in malignancy detection (p = 1.000) or identification of the affected side, whereas tumor grading differed significantly (p < 0.001), with surgical biopsy remaining more accurate. US-CNB is an accurate and reliable alternative to surgical biopsy and is recommended as the first-line option for diagnosing breast masses, although tumor grade should be interpreted with caution.