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.

Implementation of Elastography Score and Strain Ratio in Combination with B-Mode Ultrasound Avoids Unnecessary Biopsies of Breast Lesions

“…Fine-needle aspiration cytology is still widely practiced in the assessment of breast masses in both palpable and non-palpable lesions because it provides a rapid, accurate and cost-effective diagnosis in many countries, including Croatia (Radhakrishna et al 2013). UK guidelines state a complete sensitivity .80%, positive predictive value of malignancy .95%, false-negative rate ,5%, false-positive rate ,1%, inadequacy rate of 3 ,25% and suspicious rate ,20%, confirming that FNAC as a very good and effective diagnostic modality (Wells et al 1994).…”

Cytomorphological study of palpable breast lumps

“…Inclusion of core needle biopsy (CNB) in the evaluation of breast lumps have been suggested by many authors because of it's significant diagnostic accuracy, histological typing typing, and tumor grading. 11 Goyal P. et. al.…”

Spectrum of Benign Breast Lesions : A Cytologic Study

“…13,14 Thus FNAC requires an excellent aspirator to obtain satisfactory material and breast cytolopathologic expertise in interpreting the breast aspiration. 15 Though the cases were reported in C1-C5 category, a specific cytologic diagnosis was given in cases wherever possible. The clinicians in our hospital preferred the disease specific diagnosis of benign breast disease to the C1-C5 category.…”