Needle core biopsy for breast lesions: An audit of 467 needle core biopsies

Abstract

Background: Breast cancer is the commonest cancer among women in urban India. Triple assessment includes clinical, radiological and cytological assessment of breast lesions. Guided core needle biopsy has replaced fine needle aspiration cytology in most of the western countries. In resource poor countries FNAC is still a very valuable and cost effective method to diagnose breast lesions. Pitfalls include increased rates of non diagnostic smears, and inadequate smears. Further procedures may be required and this increases the cost, anxiety and delay in diagnosis. Aims: The aim of this study is to analyze the concordance of radiological and histopathology findings in BI-RADS category 3,4,5 lesions following a core biopsy. Materials and Methods: Data was retrospectively collected from consecutive symptomatic and opportunistic screen detected patients with abnormalities who underwent ultrasound guided interventional procedures from Jan 2010 to Aug 2011. Symptomatic patients underwent clinical examination, mammogram and breast ultrasound. Women under 35 years of age had only breast ultrasound. Core biopsy was performed under ultrasound guidance or clinically by a breast surgeon/ radiologist for BI-RADS category 3,4,5 lesions. Statistical Methods: Chi square test was done to show the strength of association of imaging findings and histopathology results of core biopsy. Results: 437 patients were symptomatic and 30 patients had screen detected abnormalities. The positive predictive value for BI-RADS 5 lesions for malignancy is 93.25% and the negative predictive value of BI-RADS category 3 lesions for cancer is 98.4%. False negative diagnosis on core biopsy was 0.85%. We were able to defer surgery in 60% of the patients with a clear radiological and pathological benign diagnosis. Conclusion: The PPV and NPV for cancer is high with needle core biopsy in BI-RADS 3,4,5 lesions. Where there is no discordance between clinical, radiology and pathology findings, surgery can be avoided in benign lesions. While in resource poor countries FNAC continues to be a valuable method in the diagnosis of palpable and non palpable breast lesions, the practice of needle core biopsy provides the most accurate and optimal diagnostic information.

Keywords

Breast lesion - fine needle aspiration cytology - needle core biopsy

Publication History

Article published online:
19 July 2021

• References

• 1 Hukkinen K, Kivisaari L, Heikkilä PS, Von Smitten K, Leidenius M. Unsuccessful preoperative biopsies, fine needle aspiration cytology or core needle biopsy, lead to increased costs in the diagnostic workup in breast cancer. Acta Oncol 2008;47:1037-45.
• 2 Masood S. Core needle biopsy versus fine-needle aspiration biopsy: Are there similar sampling and diagnostic issues? Breast J 2003;9:145-6.
• 3 Cobb CJ, Raza AS. Obituary: "Alas poor FNA of breast-we knew thee well!". Diagn Cytopathol 2005;32:1-4.
• 4 Zardawi IM. Fine needle aspiration cytology in a rural setting. Acta Cytol 1998;42:899-906.
• 5 Feoli F, Paesmans M, Van Eeckhout P. Fine needle aspiration cytology of the breast: Impact of experience on accuracy, using standardized cytologic criteria. Acta Cytol 2008;52:145-51.
• 6 He Q, Fan X, Yuan T, Kong L, Du X, Zhuang D, et al. Eleven years of experience reveals that fine-needle aspiration cytology is still a useful method for preoperative diagnosis of breast carcinoma. Breast 2007;16:303-6.
• 7 Mendoza P, Lacambra M, Tan PH, Tse GM. Fine needle aspiration cytology of the breast: The nonmalignant categories. Patholog Res Int 2011;2011:547580.
• 8 Vargas HI, Masood S. Implementation of a minimally invasive breast biopsy program in countries with limited resources. Breast J 2003;9 Suppl 2:S81-5.
• 9 Nassar A. Core needle biopsy versus fine needle aspiration biopsy in breast - A historical perspective and opportunities in the modern era. Diagn Cytopathol 2011;39:380-8.
• 10 Tse GM, Tan PH. Diagnosing breast lesions by fine needle aspiration cytology or core biopsy: Which is better? Breast Cancer Res Treat 2010;123:1-8.
• 11 Ballo MS, Sneige N. Can core needle biopsy replace fine-needle aspiration cytology in the diagnosis of palpable breast carcinoma. A comparative study of 124 women. Cancer 1996;78:773-7.
• 12 Britton PD. Fine needle aspiration or core biopsy. Breast 1999;20:620-4.
• 13 Fornage BD. Sonographically guided needle biopsy of nonpalpable breast lesions. J Clin Ultrasound 1999;27:385-98.
• 14 Shannon J, Douglas-Jones AG, Dallimore NS. Conversion to core biopsy in preoperative diagnosis of breast lesions: Is it justified by results? J Clin Pathol 2001;54:762-5.
• 15 Vimpeli SM, Saarenmaa I, Huhtala H, Soimakallio S. Large-core needle biopsy versus fine-needle aspiration biopsy in solid breast lesions: Comparison of costs and diagnostic value. Acta Radiol 2008;49:863-9.
• 16 Knight R, Horiuchi K, Parker SH, Ratzer ER, Fenoglio ME. Risk of needle-track seeding after diagnostic image-guided core needle biopsy in breast cancer. JSLS 2002;6:207-9.
• 17 Harter LP, Curtis JS, Ponto G, Craig PH. Malignant seeding of the needle track during stereotaxic core needle breast biopsy. Radiology 1992;185:713-4.
• 18 Youk JH, Kim EK, Kim MJ, Lee JY, Oh KK. Missed breast cancers at US-guided core needle biopsy: how to reduce them. Radiographics. 2007 Jan-Feb;27:79-94