Rate of insufficient samples for fine-needle aspiration for nonpalpable breast lesions in a multicenter clinical trial

Pisano, Etta D.; Fajardo, Laurie L.; Tsimikas, John V.; Sneige, Nour; Frable, William J.; Gatsonis, Constantine; Evans, W. Phil; Tocino, Irena; McNeil, Barbara J.

doi:10.1002/(sici)1097-0142(19980215)82:4<679::aid-cncr10>3.0.co;2-v

Cited by 128 publications

(49 citation statements)

References 40 publications

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“…It is known that the sensitivity of FNAC is the lowest when performed stereotactically (Britton, 1999), especially in the assessment of microcalcifications (Pisano et al, 1998), and our findings in this large study confirm this observation. Cores performed for microcalcification were radiographed to confirm the presence of calcium, which obviously improved the adequacy of samples contributing to the improved diagnosis of DCIS by CB.…”

Section: Discussionsupporting

confidence: 88%

Role of fine-needle aspiration cytology and core biopsy in the preoperative diagnosis of screen-detected breast carcinoma

2006

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Core biopsy (CB) has now largely replaced fine-needle aspiration cytology (FNAC) in the preoperative assessment of breast cancer in the UK. We studied the contribution of FNAC and CB in the preoperative diagnosis of screen-detected breast carcinoma. Data were prospectively collected on 150 840 women who underwent breast screening over a 4-year period from 1999 to 2003. Data on women who had both FNAC and CB taken from the same lesion preoperatively and in whom surgical excision of the lesion subsequently confirmed malignancy was analysed. In 763 cancers, FNAC was inadequate (C1) in 8% and benign (C2) in 10%. Most of these cases presented with microcalcification (25% were C1 or C2). Core biopsy was not representative (B1) or benign (B2) in 7%. The absolute and complete sensitivities were 65 and 82% for FNAC and 80 and 93% for CB in the diagnosis of cancer. Core biopsy was abnormal (B3 or above) in 86% of the cancers missed by FNAC and FNAC was abnormal (C3 or above) in 65% of those missed by CB. Core biopsy is better than FNAC at preoperative diagnosis of screen-detected breast cancer as it missed fewer cancers. However, combining FNAC resulted in a better preoperative diagnosis rate. The National Health Service Breast Screening Programme (NHSBSP) was introduced in the United Kingdom in 1987, following publication of the findings of an expert committee the previous year. At present, all women aged 50 -70 years are offered two-view screening mammography every 3 years. Patients with radiologically suspicious lesions are recalled for further assessment that may include clinical examination, special mammographic views, ultrasound and collection of tissue for pathological assessment by fine-needle aspiration cytology (FNAC), core biopsy (CB), or more recently, by wide bore vacuum biopsy.In the early stages of NHSBSP, FNAC was the test used in the assessment. Core biopsy was introduced in the assessment process in late 1990s. The experience with this technique has improved considerably and CB is now considered to be the standard. The preoperative diagnosis rate of screen-detected carcinoma has been improving with increasing use of CB. Correspondingly, the use of FNAC is in decline and a number of screening units in the UK have abandoned it completely (Britton et al, 1997).At the Bedfordshire and Hertfordshire Breast Screening Unit, CB was introduced in the assessment of screen-detected breast lesions in 1997, but we continued to perform FNAC in addition in the majority of patients with suspicious lesions. The aim of this study was to assess the performance of FNAC and CB in the preoperative diagnosis of screen-detected breast carcinoma. MATERIALS AND METHODSData were prospectively collected on all women who attended the Bedfordshire and Hertfordshire Breast Screening Unit, England. We reviewed a 4-year period from April 1999 to March 2003. This period was chosen to ensure that operators had gained sufficient expertise in the use of CB, which was introduced in 1997. We selected, for detailed analysis, the women who had ...

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Section: Discussionsupporting

confidence: 88%

Role of fine-needle aspiration cytology and core biopsy in the preoperative diagnosis of screen-detected breast carcinoma

2006

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“…Fine-needle aspiration cytology is an inexpensive and easy technique, but with a limited reliability, as it presents false negatives and an excessive rate of inadequate specimens [4,5]. It is especially ineffective on NPLs with calcifications, where inadequate samples can reach 50% [5].…”

Section: Introductionmentioning

confidence: 99%

“…It is especially ineffective on NPLs with calcifications, where inadequate samples can reach 50% [5]. Finally, FNA cytology does not provide information on the in situ or invasive character of the malignant NPLs, which means that in a great number of cases it does not reduce the number of surgical procedures.…”

Section: Introductionmentioning

confidence: 99%

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Vacuum-assisted breast biopsy on digital stereotaxic table of nonpalpable lesions non-recognisable by ultrasonography

et al. 2002

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The aim of this study was to evaluate accuracy of 11 G vacuum-assisted percutaneous biopsy (VAPB) carried out on digital stereotaxic table, on breast non-palpable lesions (NPLs), non-visible by US. Prospective study on 132 consecutive NPLs (126 patients) not reliably found by US; 82% showed microcalcifications. Surgical confirmation was obtained in all malignant cases and when VAPB reported atypical lesion (ductal or lobular), radial scar or atypical papillary lesion. All patients with benign results were included in a mammographic follow-up programme. Two cases could not be dealt with due to technical difficulties. One to 26 cylinders were obtained from the remaining 130 NPLs. Sixty-four lesions were surgically confirmed. Forty-six of the 47 malignancies were correctly diagnosed. In one case of a malignant tumour, an atypical lesion was classified with VAPB. All cases of histologically verified lobular carcinoma in situ, atypical ductal or lobular hyperplasia, radial scar or atypical papillary lesion were correctly diagnosed preoperatively. The remaining lesions were benign in VAPB, and after 1 year of follow-up, no false negative has been found. Based on this short-term follow-up, absolute sensitivity was 97.9%, absolute specificity 84.3% and accuracy was 99.2%. For predicting invasion, accuracy was 89.1%. Vacuum-assisted percutaneous biopsy is a very accurate technique for NPLs which are not detectable by US. It can replace approximately 90% of DSB with no important complications, avoiding scars and providing a higher level of comfort.

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“…In this setting, both CNB and FNAC are initial investigations of choice, and many studies have been done comparing these two modalities [11][12][13][14][15][16][17]. Direct comparison of the results of various FNAC studies may not be appropriate, as the defining conditions of various diagnostic categories, technical details, and other parameters may not be the same [3].…”

Section: Non Palpable Mammographic Detected Lesionsmentioning

confidence: 99%

Diagnosing breast lesions by fine needle aspiration cytology or core biopsy: which is better?

Tse

Tan

2010

Breast Cancer Res Treat

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Fine needle aspiration cytology (FNAC) and core needle biopsy (CNB) are widely used in diagnosing breast lesions, with both achieving high sensitivity and specificity. Whether FNAC or CNB is better remains highly controversial. In this review, the advantages and disadvantages of each of these methods are discussed, especially in relation to specific problematic groups of breast lesions. In general, CNB has a slight advantage with lower inadequate and suspicious rates, allowing easier grade assessment and ancillary testings (hormome receptors, HER2) in cases of cancers. FNAC cannot reliably predict invasion in a malignant aspirate, whereas CNB, although useful in confirming invasion in carcinomas, has a much lower efficacy in predicting invasion when only in situ carcinoma is detected. The other problematic areas are papillary breast lesions and fibroepithelial lesions, notably phyllodes tumors. In papillary lesions, FNAC diagnosis is inaccurate, but with CNB, one can confidently diagnose papillary lesion, although there is still significant false positive and false negative rates, even with immunohistochemistry. For fibroepithelial lesions, using either FNAC or CNB to differentiate between a phyllodes tumor from fibroadenoma is also inaccurate. As management of breast diseases necessitates the triple approach (clinical, imaging and pathological), an awareness of the limitations of these very useful diagnostic modalities by all specialists is prudent, especially when dealing with these specific groups of breast lesions.

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Rate of insufficient samples for fine-needle aspiration for nonpalpable breast lesions in a multicenter clinical trial

Cited by 128 publications

References 40 publications

Role of fine-needle aspiration cytology and core biopsy in the preoperative diagnosis of screen-detected breast carcinoma

Role of fine-needle aspiration cytology and core biopsy in the preoperative diagnosis of screen-detected breast carcinoma

Vacuum-assisted breast biopsy on digital stereotaxic table of nonpalpable lesions non-recognisable by ultrasonography

Diagnosing breast lesions by fine needle aspiration cytology or core biopsy: which is better?

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