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Bondera T, Schubert P, van Zyl A, Pitcher R, Bagadia A. Diagnostic yield and accuracy of paediatric image-guided fine needle aspiration biopsy of deep organ tumours. SA J Radiol 2022; 26:2485. [PMID: 36262828 PMCID: PMC9575341 DOI: 10.4102/sajr.v26i1.2485] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 06/23/2022] [Indexed: 11/01/2022] Open
Abstract
Background Paediatric tumour cytological diagnosis by image-guided fine needle aspiration biopsy (FNAB) with rapid on-site evaluation (ROSE) has not gained wide acceptance despite increasing publications advocating the procedure. Objective The primary aim was an audit of the diagnostic yield and accuracy of paediatric image-guided FNAB with ROSE at a single institution. Evaluation of safety was a secondary aim. Method Details of consecutive cases of paediatric image-guided FNAB with ROSE for suspected non-benign deep-seated lesions performed from 01 January 2014 to 30 April 2020 were retrieved from the institutional radiology and laboratory databases. Diagnostic yield and accuracy were evaluated using clinico-pathological-radiological correlation and/or subsequent histological specimen diagnosis correlation. Complications and the frequency of key radiological features potentially affecting yield and accuracy were described. Results Of 65 cases retrieved, cytology showed malignancy in 52, benign features in five and one indeterminate diagnosis; seven samples were insufficient for cytological assessment. Of the 65 cases, 58 had subsequent formal histological diagnosis. The overall diagnostic yield was 98.5%, with 94.5% sensitivity, 100.0% specificity, 100.0% positive predictive value, 75.0% negative predictive value and 95.3% diagnostic accuracy. All cases (n = 26) demonstrating restricted diffusion on MRI yielded adequate samples and cyto-histopathological correlation. Conclusion Paediatric image-guided FNAB with ROSE has a relatively high diagnostic yield, sensitivity, specificity, positive predictive value and accuracy in the diagnosis of deep-seated tumours. The relatively low negative predictive value may reflect insufficient samples obtained from cystic and/or benign lesions. Sampling from areas of restricted MRI diffusion may enhance diagnostic yield.
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Affiliation(s)
- Tichayedza Bondera
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Pawel Schubert
- Division of Anatomical Pathology, Faculty of Medicine and Health Sciences, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa
| | - Anel van Zyl
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Richard Pitcher
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Asif Bagadia
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Bennett IC, Saboo A. The Evolving Role of Vacuum Assisted Biopsy of the Breast: A Progression from Fine-Needle Aspiration Biopsy. World J Surg 2019; 43:1054-1061. [PMID: 30617562 DOI: 10.1007/s00268-018-04892-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND The management of breast disease has been greatly facilitated by the technology of needle biopsy interventions, and over the past 30 years, this has evolved from the use of fine-needle aspiration biopsy (FNAB) to the current methodology of vacuum assisted biopsy (VAB). METHODS This article provides an historical review of the application of needle interventions of the breast in the diagnosis and management of breast conditions, and discusses current indications for the use of vacuum assisted biopsies and vacuum assisted excisions. RESULTS Whilst FNAB continues to have a limited role in breast disease diagnosis, the necessity of achieving an histological diagnosis has preferentially seen the development and wider application of automated core needle biopsies (CNB) and VAB in the assessment and management of breast lesions. The advantages of CNB and VAB include the ability to distinguish in situ and invasive disease pre-operatively, and the ability to achieve prior knowledge of immunohistochemical tumour markers particularly in the setting of neoadjuvant drug treatments. CONCLUSION Due to its ability to obtain larger tissue samples, VAB does have diagnostic advantages over CNB and indications for the utilization of VAB are discussed. VAB additionally has an expanding role as a tool for breast lesion excision.
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Affiliation(s)
- Ian C Bennett
- Breast and Endocrine Surgical Unit, Princess Alexandra Hospital, University of Queensland, Woolloongabba, Brisbane, QLD, Australia.
| | - Apoorva Saboo
- Breast and Endocrine Surgical Unit, Princess Alexandra Hospital, University of Queensland, Woolloongabba, Brisbane, QLD, Australia
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3
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Topps AR, Barr SP, Pikoulas P, Pritchard SA, Maxwell AJ. Pre-operative Axillary Ultrasound-Guided Needle Sampling in Breast Cancer: Comparing the Sensitivity of Fine Needle Aspiration Cytology and Core Needle Biopsy. Ann Surg Oncol 2017; 25:148-153. [PMID: 29063297 DOI: 10.1245/s10434-017-6090-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Indexed: 01/14/2023]
Abstract
BACKGROUND Pre-operative ultrasound-guided needle sampling (UNS) of abnormal axillary lymph nodes in breast cancer can identify patients with axillary metastases and therefore rationalize patient care and inform decision-making. To obtain tissue diagnosis, UNS can be performed by either fine needle aspiration (FNA) or core needle biopsy (CNB). However, few studies have compared the sensitivity of these techniques and the majority show no difference. METHODS All node-positive patients (those with micro- and macrometastases but not isolated tumor cells) treated at a tertiary referral center between January 2012 and December 2015 were retrospectively identified from pathology records. The result of the first axillary UNS performed on each patient was compared with postoperative histopathology results. The UNS method used was according to individual radiologist preference. RESULTS A total of 215 patients underwent FNA (1 patient had bilateral breast cancer and underwent bilateral FNA), and 92 underwent CNB. Sensitivity of CNB was significantly higher than FNA (83.7 vs. 69.0%, P = 0.008). The false-negative rate in the FNA group was therefore higher than in the CNB group by a factor of 2.5. There was no difference in inadequacy rate between the two techniques. There were no complications in the FNA group, and only one hematoma (which did not require operative intervention) in the CNB group. CONCLUSIONS CNB is safe and should be the preferred technique for UNS to improve sensitivity.
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Affiliation(s)
- Ashley R Topps
- Nightingale Centre, University Hospital of South Manchester, Manchester, UK. .,Burnley General Hospital, Burnley, Lancashire, UK.
| | - Simon P Barr
- Nightingale Centre, University Hospital of South Manchester, Manchester, UK
| | | | - Susan A Pritchard
- Department of Histopathology, University Hospital of South Manchester, Manchester, UK
| | - Anthony J Maxwell
- Nightingale Centre, University Hospital of South Manchester, Manchester, UK.,School of Health Sciences, University of Manchester, Manchester, UK
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Mitra S, Dey P. Fine-needle aspiration and core biopsy in the diagnosis of breast lesions: A comparison and review of the literature. Cytojournal 2016; 13:18. [PMID: 27651820 PMCID: PMC5019018 DOI: 10.4103/1742-6413.189637] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 03/24/2016] [Indexed: 12/01/2022] Open
Abstract
In recent times, the diagnosis of breast lesions has mostly become dependent on core needle biopsies (CNBs) with a gradual reduction in the rate of performing fine-needle aspiration cytology (FNAC). Both the procedures have their pros and cons and outsmart each other taking into account different parameters. Both the methods are found to be fraught with loopholes, taking into account different performance indices, diagnostic accuracy and concordance, patient benefit, and cost-effectiveness. Unlike the popular belief of an absolute superiority of CNB over FNAC, the literature review does not reveal a very distinct demarcation in many aspects. We recommend judicious use of these diagnostic modalities in resource-limited settings and screening programs taking into account parameters such as palpability and availability of an experienced cytopathologist.
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Affiliation(s)
- Suvradeep Mitra
- Address: Department of Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pranab Dey
- Department of Cytopathology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Joudeh AA, Shareef SQ, Al-Abbadi MA. Fine-Needle Aspiration Followed by Core-Needle Biopsy in the Same Setting: Modifying Our Approach. Acta Cytol 2016; 60:1-13. [PMID: 26963594 DOI: 10.1159/000444386] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 01/29/2016] [Indexed: 01/01/2023]
Abstract
Fine-needle aspiration biopsy (FNAB) is a well-established initial diagnostic tool. However, in some instances limitations and shortcomings arise, making it insufficient for determining a specific diagnosis. Consequently, patients have to undergo another diagnostic procedure. The second procedure is either repeat FNAB, core-needle or open biopsy, and can be inconvenient and costly. In some centers, the FNAB is immediately followed by core-needle biopsy (CNB) in the same setting after assuring adequacy on the initial FNAB utilizing rapid on-site specimen evaluation (ROSE). It is argued that implementing such an approach will eventually have additional critical advantages that include the following: (a) it is more convenient to patients to have both procedures in one visit, (b) the tissue procured by both procedures will be more adequate, enabling cytopathologists to reach an accurate diagnosis, and (c) it is ultimately a cost-effective approach if we take into consideration the avoidance of a potential second more invasive diagnostic procedure. Since we are living in an era of patient-centered medicine coupled with cost-cutting strategies, we present here a brief review of the topic with analysis of this alternative approach, review of the pertinent literature and shed light on a few scenarios that justify this approach.
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Affiliation(s)
- Amani A Joudeh
- Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital, Dammam, Kingdom of Saudi Arabia
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6
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Shariff S. Changing Paradigms in Breast Carcinoma:A Review. JOURNAL OF MEDICAL SCIENCES AND HEALTH 2015. [DOI: 10.46347/jmsh.2015.v01i02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Kurita T, Tsuchiya SI, Watarai Y, Yamamoto Y, Harada O, Yanagihara K, Iida S, Yamashita K, Haga SS, Uchida E. Roles of fine-needle aspiration and core needle biopsy in the diagnosis of breast cancer. Breast Cancer 2011; 19:23-9. [DOI: 10.1007/s12282-010-0251-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2010] [Accepted: 12/21/2010] [Indexed: 10/18/2022]
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8
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Bukhari MH, Akhtar ZM. Comparison of accuracy of diagnostic modalities for evaluation of breast cancer with review of literature. Diagn Cytopathol 2009; 37:416-24. [PMID: 19217034 DOI: 10.1002/dc.21000] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
This study was conducted to confirm which of these modalities [mammography (MG), fine-needle aspiration cytology (FNAC), core-needle biopsy (CNB), or intraoperative touch imprint cytology (IOTIC)] is useful to detect breast cancer and to compare the accuracy of these modalities for the diagnostic setting. One hundred seventy-five, 85, 78, and 25 patients were selected who underwent FNAC, MG, IOTIC, and CNB, respectively. Histopathology was used as a gold standard for comparison of the results of all diagnostic modalities. Twenty-five patients with combinations of three preoperative tests (MG, FNAC, CNB) showed 100% accurate results when compared with histopathology, while the overall accuracy for MG, FNAC, and CNB was 91.7%, 91.5%, and 96%, respectively. Both touch and scrape imprints' sensitivity, specificity, positive predictive value, negative predictive value (NPV), and accuracy were 100% for class V and class II smears, while sensitivity, accuracy, and NPV were 87, 95, and 83% for IOTIC and 94%, 96%, and 89% for IOSC for class III and IV smears. On comparison of the results of all these procedures, the difference was nonspecific (P = 0.2, 0.3, 0.5, 0.55, and 0.6 for MG, FNAC, IOTI, IOSC, and CNB, respectively). Combinations of preoperative tests (MG, FNAC, CNB) were more accurate, reliable, and acceptable when compared with individual diagnostic procedure, but these have their own technical limitations. The accuracy of CNB was much higher than that of MG and FNAC. IOTP and IOSC are simple and cost effective diagnostic tests with better accuracy that can be used as an alternate to frozen section in diagnostic settings and margin assessments.
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9
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Cangiarella JF, Waisman J, Weg N, Tata M, Gross J, Symmans WF. The Use of Stereotaxic Core Biopsy and Stereotaxic Aspiration Biopsy as Diagnostic Tools in the Evaluation of Mammary Calcification. Breast J 2008; 6:366-372. [PMID: 11348394 DOI: 10.1046/j.1524-4741.2000.99095.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We compared stereotaxic fine needle aspiration biopsy (SFNA) with stereotaxic core needle biopsy (SCB) in the evaluation of radiographically clustered mammary microcalcification, a common finding at screening mammography. Over a 4-year period, 181 specimens were obtained from 175 patients who underwent both SFNA and SCB of clustered microcalcification. Aspiration and core biopsies were performed by radiologists at a community-based diagnostic radiology facility. All aspiration smears were air dried, stained on site, and assessed for adequacy by the radiologists, then sent to the cytopathologists at New York University for interpretation. Core biopsy specimens were formalin fixed, paraffin embedded, hematoxylin and eosin stained, and interpreted by surgical pathologists at a community hospital. Of 181 SFNA specimens, 133 (74%) were benign, 18 (10%) were atypical, 13 (7%) were suspicious, and 16 (9%) were malignant. One (0.5%) aspiration biopsy was nondiagnostic. Excisional biopsies were performed after 12 benign SFNAs and in 46 of the 47 cases with an atypical, suspicious, or malignant diagnosis on SFNA. Mammographic follow-up in 111 of the 133 cases (92%) diagnosed as benign showed no radiologic change (mean 29.2 months, range 6-60 months). The false-negative rate for cancer was 4% (6 cases) for SFNA alone. There were no false-positive diagnoses for SFNA. There was one false-positive diagnosis on core biopsy [focal cribriform ductal carcinoma in situ (DCIS)], which at excisional biopsy and correlation with the core biopsy was diagnosed as ductal hyperplasia; the false-negative rate for cancer was 8% (13 cases) for SCB alone. Aspiration biopsy identified calcification in 180 procedures, core needle biopsy revealed calcification in 170. SFNA was superior to SCB for the confirmation of clustered mammary microcalcification (99% versus 94%) and in the identification of cancer associated with microcalcification (false negative rate of 4% versus 8%). Patients with benign findings on stereotaxic aspiration and core biopsy can reasonably be followed mammographically.
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Affiliation(s)
- Joan F. Cangiarella
- Department of Pathology, New York University Medical Center, New York, New York; Noah Weg and Associates, Diagnostic Radiology, Suffern, New York; Good Samaritan Hospital, Suffern, New York, and Beth Israel Medical Center, New York, New York
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10
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Barra ADA, Gobbi H, de L. Rezende CA, Gouvêa AP, de Lucena CÊM, Reis JHP, Costa e Silva SZ. A comparision of aspiration cytology and core needle biopsy according to tumor size of suspicious breast lesions. Diagn Cytopathol 2007; 36:26-31. [DOI: 10.1002/dc.20748] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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11
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Pilgrim S, Ravichandran D. Fine needle aspiration cytology as an adjunct to core biopsy in the assessment of symptomatic breast carcinoma. Breast 2005; 14:411-4. [PMID: 16216746 DOI: 10.1016/j.breast.2004.11.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2004] [Revised: 10/19/2004] [Accepted: 11/04/2004] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION Core biopsy (CB) has now largely replaced fine needle aspiration cytology (FNAC) in the pre-operative assessment of breast cancer. We studied the contribution of FNAC, when done as an adjunct to CB, in cancer patients presenting symptomatically. PATIENTS 112 patients had both CB and FNAC pre-operatively and subsequently had surgery (wide local excision or mastectomy). CB & FNAC were done clinically in half the patients and under ultrasound guidance in the majority of others. RESULTS The complete sensitivity of FNAC was 90% and that of CB was 99%. Absolute sensitivity was 67% and 94%, respectively. CB was not suspicious of malignancy (B1) only in 1 patient in whom FNAC was suspicious (C3). In this patient there was a high degree of suspicion of breast cancer clinically & radiologically so a negative CB would not have been accepted even in the absence of FNAC. CONCLUSIONS FNAC, when performed in addition to CB, does not provide useful additional information in symptomatic breast cancer patients.
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Affiliation(s)
- S Pilgrim
- Breast Unit, Luton & Dunstable Hospital, Lewsey Road, Luton, Bedfordshire LU4 0DZ, UK
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12
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Cheng MSP, Fox J, Hart SA. Impact of core biopsy on the management of screen-detected ductal carcinoma in situ of the breast. ANZ J Surg 2003; 73:404-6. [PMID: 12801338 DOI: 10.1046/j.1445-2197.2003.t01-1-02656.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Screen-detected ductal carcinoma in situ (DCIS) usually presents as clinically impalpable microcalcification. Although core biopsy is well established as a diagnostic modality for invasive breast cancers, few reports address its impact on the management of screen-detected DCIS. We examined the sensitivity of core biopsy in diagnosing screen-detected DCIS, as well as its role in facilitating one-step surgery in the community, especially a breast-conserving approach. METHODS Through the Monash BreastScreen database, we reviewed the management of 148 patients diagnosed with pure DCIS over a 4-year period. Particular attention was paid to the sensitivity and surgical margin status of 63 patients who underwent initial assessment with core biopsy, compared to patients who underwent excisional biopsy or fine needle aspiration cytology (FNAC). RESULTS Core specimens in 63 patients yielded positive histology in 57 (90%), allowing for breast-conserving surgery in 45 and mastectomy in 12. Negative margins were obtained in 73% of those treated by breast-conserving surgery, compared to 51% negative margins among those who underwent excisional biopsy initially. Overall, 45 of 57 patients with a positive core biopsy histology (79%) underwent one-step surgery. Those assessed by FNAC had a 48% incidence of non-diagnostic/benign cytology. CONCLUSIONS Core biopsy facilitates one-step surgery for screen-detected DCIS, and potentially reduces the number of surgical procedures. Stereotactic core biopsy for suspicious microcalcifications should replace hookwire-guided excisional biopsy and FNAC as the diagnostic modality of choice.
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Affiliation(s)
- Michael S P Cheng
- Monash BreastScreen and Breast Unit, Monash Medical Centre, Melbourne, Victoria, Australia.
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13
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Ernst MF, Roukema JA. Diagnosis of non-palpable breast cancer: a review. Breast 2002; 11:13-22. [PMID: 14965640 DOI: 10.1054/brst.2001.0403] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2000] [Revised: 06/14/2001] [Accepted: 06/21/2001] [Indexed: 11/18/2022] Open
Abstract
The literature on several methods of diagnosing non-palpable breast carcinoma has been reviewed. Skin projection and dye are methods not frequently used. Several aspects of FNA biopsy/cytology, ultrasound-directed methods, frozen section and MRI localization procedures are highlighted and comparisons are made. Much attention is being payed to needle localization breast biopsy and stereotactic core needle breast biopsy. The management of patients with mammographic abnormalities is shifting from needle localization to breast biopsy stereotactic core needle biopsy. Items of comparison between the two mentioned methods are accuracy, indications, complications and costs. The role of the ABBI system in the management of breast cancer has not yet been defined. A cooperative effort between the mammographer, surgeon and pathologist is critical to a successful image-guided breast biopsy programme.
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Affiliation(s)
- M F Ernst
- Department of Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands.
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14
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Yeow KM, Lo YF, Wang CS, Chang HK, Tsai CS, Hsueh C. Ultrasound-guided core needle biopsy as an initial diagnostic test for palpable breast masses. J Vasc Interv Radiol 2001; 12:1313-7. [PMID: 11698631 DOI: 10.1016/s1051-0443(07)61557-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To determine the role of ultrasound (US)-guided core needle biopsy as an initial diagnostic test for palpable breast masses. MATERIALS AND METHODS Ninety-eight consecutive patients, each with a palpable breast mass, were referred for US-guided core biopsy by a multidisciplinary team of physicians who specialize in the care of breast diseases. All palpable breast masses were clearly visible on high-resolution US. Ninety-nine core needle biopsies were performed under local anesthesia with use of freehand technique, mostly in an outpatient setting. Core needle path through each mass was documented in two orthogonal sections. A mean of 3.4 tissue core samples (range, 1-7) were obtained in each patient. RESULTS Core needle biopsy resulted in the diagnosis of 66 malignancies, two cases of atypical ductal hyperplasia (ADH), and 30 benign diseases of the breast. Surgery with curative intent was performed in 63 breast malignancies and excisional biopsies were performed for 10 benign diseases (two cases of ADH and eight benign lesions). Twenty-five breast masses were managed nonoperatively: chemotherapy was performed in three locally advanced breast cancers and 3-year follow-up was conducted for 22 benign lesions. Malignancies were correctly diagnosed in all cases. No malignancy was discovered at surgery or during clinical follow-up of ADH and no benign breast lesions were diagnosed by core needle biopsy. US-guided core needle biopsy is 100% sensitive and specific for palpable breast malignancies, with no false-positive results. A puncture site ecchymosis was the only morbidity or complication noted. CONCLUSION US-guided core needle biopsy is a safe and accurate first diagnostic test for palpable breast masses that require tissue proof.
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Affiliation(s)
- K M Yeow
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chang Gung University, Tao Yuan, Taiwan, Republic of China.
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15
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Vargas HI, Agbunag RV, Khaikhali I. State of the art of minimally invasive breast biopsy: principles and practice. Breast Cancer 2001; 7:370-9. [PMID: 11114867 DOI: 10.1007/bf02966407] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In the last two decades, the increasing use of screening mammography with the early detection of breast cancer and the newly gained understanding of the biology and changing therapy of breast cancer, emphasizing systemic therapy and minimizing extensive local surgery, has contributed to the increasing development of minimally invasive techniques for the diagnosis of breast lesions. Minimally invasive techniques provide increased patient comfort, excellent cosmetic result and minimal morbidity They are also responsible for decreased costs and better medical care by allowing an informed discussion of breast cancer therapy and planning of surgery with an emphasis on negative margins and the dissection of the sentinel node. Techniques in use include Fine-Needle Aspiration Cytology, Core-Needle biopsy, Vacuum-Assisted Core biopsy (Mammotome) and Large Core biopsy (ABBI, Site-select). We present a balanced, evidence-based approach to the diagnosis of patients with palpable or mammographic abnormalities.
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Affiliation(s)
- H I Vargas
- Surgical Oncology, Harbor-UCLA Medical Center, 1000 W. Carson Street, Box 25, Torrance, CA 90509, USA
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Westenend PJ, Sever AR, Beekman-De Volder HJ, Liem SJ. A comparison of aspiration cytology and core needle biopsy in the evaluation of breast lesions. Cancer 2001; 93:146-50. [PMID: 11309781 DOI: 10.1002/cncr.9021] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Several arguments are used for choosing either fine-needle aspiration cytology (FNAC) or core needle biopsy (CNB) in the evaluation of breast lesions. Comparison of published data on both methods is complicated by differences in study design, calculations, and operator experience. The objective of this study was to make a direct comparison of both methods. METHODS In 286 breast lesions (cysts and microcalcifications without a soft tissue mass excluded), both ultrasound-guided FNAC and CNB were performed in the same session by the same operator. Histologic follow-up was collected, and for those lesions that were not excised the results of the most recent mammography was used. A combination of the findings of both FNAC and CNB were evaluated. RESULTS Core needle biopsy and FNAC do equally well for sensitivity (88% vs. 92%), positive predictive value for malignancy (99% vs. 100%), and inadequate rate (7% vs. 7%). However, statistical differences are found for the specificity (CNB, 90%; FNAC, 82%). In addition, differences are found in the positive predictive value of both suspicious (CNB, 100%; FNAC, 78%) and atypia (CNB, 80%; FNAC, 18%) and for the suspicious rate (CNB, 5%; FNAC, 13%) reflecting difficulties in interpreting some FNACs. Combining the findings of both FNAC and CNB results in an increase in absolute sensitivity, a decrease in the positive predictive value of atypia compared with FNAC and CNB per se, and a decrease in the inadequate rate for cancers. CONCLUSIONS For the lesions selected in this study, FNAC and CNB are comparable for most parameters, but CNB has a higher specificity and lower suspicious rate. Combining results of FNAC and CNB leads to an increase in absolute sensitivity without affecting specificity and a decrease in the inadequate rate for cancers.
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Affiliation(s)
- P J Westenend
- Laboratory for Pathology, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
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17
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Denley H, Pinder SE, Elston CW, Lee AH, Ellis IO. Preoperative assessment of prognostic factors in breast cancer. J Clin Pathol 2001; 54:20-4. [PMID: 11271783 PMCID: PMC1731277 DOI: 10.1136/jcp.54.1.20] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The adoption of preoperative diagnostic strategies involving fine needle aspiration cytology (FNAC) or core biopsy is well established, allowing the planning of operating lists and bed occupancy and patient involvement in therapeutic management. In addition to diagnosis, however, pathologists are increasingly being asked to provide pathological prognostic information from preoperative samples. This leader describes techniques for predicting prognosis and response to treatment on these specimens and some of the problems inherent in the determination of prognosis on small samples. For example, although histological grade can be assessed relatively reliably on either core or FNAC samples, the evaluation of tumour type (which includes an overall assessment of the architecture of a given tumour) may be less reliable on small preoperative samples. Other well recognised histological prognostic factors, such as vascular channel invasion or tumour size, cannot be determined accurately on small preoperative samples. For those patients who might benefit from neoadjuvant treatment, predicting the response to such treatments--for example, by the assessment of oestrogen receptor status--can readily be performed on either core biopsy or FNAC. In the future, other molecular markers such as C-erbB-2 might also prove beneficial in predicting response to newly developed treatments.
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Affiliation(s)
- H Denley
- Department of Histopathology, Nottingham City Hospital NHS Trust, Hucknall Road, Nottingham NG5 1PB, UK.
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19
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Kitchen PR, Cawson JN. The evolving role of fine needle cytology and core-biopsy in the diagnosis of breast cancer. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1996; 66:577-9. [PMID: 8859152 DOI: 10.1111/j.1445-2197.1996.tb00821.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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