Clinical practice guidelines for ultrasound-guided breast lesions and lymph nodes biopsy: Chinese society of breast surgery (CSBrS) practice guidelines 2021

In order to standardize the practice of ultrasound-guided breast and regional lymph node biopsy, and provide a reference for Chinese breast surgeons, based on the version of Consensus statements and operation guidelines on breast lesions and lymph nodes biopsy guided by ultrasound (2019),[1] the Chinese Society of Breast Surgery (CSBrS) has re-evaluated the quality of the evidence of relevant clinical studies referring to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) handbook and considered domestic medical condition to develop the Clinical Practice Guidelines for Ultrasound-guided Breast Lesions and Lymph Nodes Biopsy: CSBrS Practice Guidelines 2021. Indications Site Indications Level of evidence Recommendation strength 1.1 Breast Lesion Breast Imaging Reporting and Data System (BI-RADS) category ≥ 4[3–5] I A 1.2 BI-RADS category 3 with a family history of breast cancer or other high-risk factors[1] II A 1.3 Possible for neoadjuvant therapy[3,4] I A 1.4 Benign lesion for further pathological classification[4] I A 1.5 Regional Lymph Node Suggested by imaging with abnormal histomorphology and (or) structure, and suspected of being metastatic[6] I A Recommendation 2: Clinical issues on breast lesion biopsy Clinical issues on breast lesion biopsy Level of evidence Recommendation strength 4.1 Needle size for breast lesion CNB 4.1.1 14G[10–12] II A 4.1.2 16G[10–12] II A 4.1.3 18G[10,12] III B 4.2 ≥4 specimens for breast lesion CNB to improve the diagnostic rate (with 14G needle)[13,14] II A 4.3 CNB or VABB specimens may have pathological underestimation of the following breast lesions 4.3.1 High-risk lesions Papilloma[15,16] I A 4.3.2 Atypical ductal hyperplasia (ADH)[4,16] I A 4.3.3 Phyllodes tumor[16,17] II A 4.3.4 Radial sclerosing lesion[16] II A 4.3.5 Carcinoma in situ[4,16] I A Discussion The contraindications of ultrasound-guided breast lesion or regional lymph node biopsy can refer to the general principles for preoperative evaluation, including severe systemic diseases, mental disorders, inability to cooperate, and severe bleeding or coagulation disorder. [...]cellular immunohistochemistry has not been popularized and standardized domestically yet. [...]the expert panel does not recommend FNAB as a first-line method for breast lesion biopsy.