Impact of Core-Needle Breast Biopsy on the Surgical Management of Mammographic Abnormalities

Abstract

ObjectiveTo evaluate the accuracy of percutaneous, image-guided core-needle breast biopsy (CNBx) and to compare the surgical management of patients with breast cancer diagnosed by CNBx with patients diagnosed by surgical needle-localization biopsy (SNLBx). Summary Background DataPercutaneous, image-guided CNBx is a less invasive alternative to SNLBx for the diagnosis of nonpalpable mammographic abnormalities. CNBx potentially spares patients with benign lesions from unnecessary surgery, although false-negative results can occur. For patients with malignant lesions, preoperative diagnosis by CNBx allows definitive treatment decisions to be made before surgery and may affect surgical outcomes. MethodsBetween 1992 and 1999, 939 patients with 1,042 mammographically detected lesions underwent biopsy by stereotactic CNBx or ultrasound-guided CNBx. Results were categorized pathologically as benign or malignant and, further, as invasive or noninvasive malignancies. Only biopsy results confirmed by excision or 1-year-minimum mammographic follow-up were included in the analysis. Patients with breast cancer diagnosed by CNBx were compared with a matched control group of patients with breast cancer diagnosed by SNLBx. ResultsBenign results were obtained in 802 lesions (77%), 520 of which were in patients with adequate follow-up. Ninety-five of the 520 evaluable lesions (18%) were subsequently excised because of atypical hyperplasia, mammographic-histologic discordance, or other clinical indications. There were 17 falsenegative CNBx results in this group; 15 of these lesions were correctly diagnosed by excisional biopsy within 4 months of CNBx. In two patients (0.9%), delayed diagnoses of ductal carcinoma in situ were made at 15 and 19 months after CNBx. Malignant results were obtained in 240 lesions (23%), 220 of which were surgically excised from 202 patients at our institution. Two lesions diagnosed as ductal carcinoma in situ were reclassified as atypical ductal hyperplasia and considered false-positive results (0.4%). For malignant lesions, the sensitivity and specificity of CNBx for the detection of invasion were 89% and 96%, respectively. During the first surgical procedure, 115 of 199 patients (58%) diagnosed by CNBx underwent local excision; 194 of 199 patients (97%) evaluated by SNLBx underwent local excision. For patients whose initial surgery was local excision, those diagnosed before surgery by CNBx had larger excision specimens and were more likely to have negative surgical margins than were patients initially evaluated by SNLBx. Overall, patients diagnosed by CNBx required fewer surgical procedures for definitive treatment than did patients diagnosed by SNLBx. ConclusionsDiagnosis by CNBx spares most patients with benign mammographic abnormalities from unnecessary surgery. With the selective use of SNLBx to confirm discordant results, missed diagnoses are rare. When compared with SNLBx, preoperative diagnosis of breast cancer by CNBx facilitates wider initial margins of excision, fewer positive margins, and f...

Effect of Advanced Imaging Technology on How Biopsies Are Done and Who Does Them

“…PNBs were originally performed blind or with fl uoroscopic guidance. PNBs had lower morbidity than open biopsies and had the added benefi ts of possibly obviating surgery and allowing for cost savings ( 3,4 ). On the other hand, because the percutaneous approach did not allow for direct visualization of organs, it was hampered by suboptimal diagnostic yields and was still prone to complications ( 5,6 ).…”

Performance Indices of Needle Biopsy Procedures for the Assessment of Screen Detected Abnormalities in Services Accredited by BreastScreen Australia

“…Almost uniformly, over 90% of all malignant lesions are being correctly diagnosed by percutaneous needle biopsies. A high peroperative diagnosis rate enables women and their doctors to discuss treatment options and plan for one stage, definitive surgical management, including axillary staging for invasive cancer (Liberman et al, 1997;Smith et al, 1997;Whitten et al, 1997;Kaufman et al, 1998;Verkooijen et al, 2001;White et al, 2001). For DCIS there is evidence that a definitive preoperative diagnosis of malignancy reduces the need for reoperation to achieve clear margins.…”

Breast Ultrasound Past, Present, and Future

“…Percutaneous image guided core-needle biopsies have almost completely replaced surgical needle-localization biopsy of breast lesions as they are faster, less invasive, less expensive, safe, and accurate, with specificity and positive predictive value for detection of malignancy nearing 100% [31]. Not only does a negative core needle biopsy prevent a patient from undergoing unnecessary surgery, but ultrasound guided core needle biopsy for malignancy reduces the incidence of positive margins after local excision and decreases the number of surgeries for definitive breast cancer treatment [31]. Ultrasound guided 14-gauge automated core biopsy was described almost 25 years ago with 100% concordance between ultrasound guided core biopsy results and surgery [32].…”