I think a lot depends on the technician, I have known some very good ones, and some shockers. The ultrasound imaging equiqment is also getting better all the time, the better and more accurate the skill and equipment the better for women with these problems. I think its always best to to for the least invasive tests first. Biopsies can cause unnecessary pain and often exacerbate the original problem, puncturing a fibroid or cyst to take samples is very dangerous without knowing the nature of the cyst or tumor, and if the sample comes back as malignant, the puncture has caused the spread of cells to the surrounding tissue and blood system.
This is also the reason I do not like mammagrams as a first step when a woman finds a breast lump, as this is often extremely painfull for a woman with FBD, and potentially deadly if there is breast cancer, as the tumor may rupture under the pressure of the imaging plates and spread the cancer cells.