Can concurrent core biopsy and fine needle aspiration biopsy improve the false negative rate of sonographically detectable breast lesions?

Abstract

BackgroundThe aims of this study were to determine the accuracy of concurrent core needle biopsy (CNB) and fine needle aspiration biopsy (FNAB) for breast lesions and to estimate the false-negative rate using the two methods combined.MethodsOver a seven-year period, 2053 patients with sonographically detectable breast lesions underwent concurrent ultrasound-guided CNB and FNAB. The sonographic and histopathological findings were classified into four categories: benign, indeterminate, suspicious, and malignant. The histopathological findings were compared with the definitive excision pathology results. Patients with benign core biopsies underwent a detailed review to determine the false-negative rate. The correlations between the ultrasonography, FNAB, and CNB were determined.ResultsEight hundred eighty patients were diagnosed with malignant disease, and of these, 23 (2.5%) diagnoses were found to be false-negative after core biopsy. After an intensive review of discordant FNAB results, the final false-negative rate was reduced to 1.1% (p-value = 0.025). The kappa coefficients for correlations between methods were 0.304 (p-value < 0.0001) for ultrasound and FNAB, 0.254 (p-value < 0.0001) for ultrasound and CNB, and 0.726 (p-value < 0.0001) for FNAB and CNB.ConclusionsConcurrent CNB and FNAB under ultrasound guidance can provide accurate preoperative diagnosis of breast lesions and provide important information for appropriate treatment. Identification of discordant results using careful radiological-histopathological correlation can reduce the false-negative rate.

Value of combined use of fine‐needle aspiration and core needle biopsy in palpable breast tumors performed by pathologist: Institut Curie experience

“…Our results show that FNA performs better than CNB in PBTs giving less unsatisfactory results for malignant lesions as shown inTable 1. It is proven4,[9][10][11][12] also by our results that combination of these two methods gives optimal results in diagnostics of both PBTs as well as ultrasound guided in both unifocal and multifocal tumors. When compared to ultrasound-guided FNA/CNB (US-FNA/CNB), there are more important differences in the data with opposite results showing that US-CNB performs better than US-FNA.…”

“…FNA and CNB are two techniques which should not be considered as two separate diagnostic methods but rather as two complementary methods 11,34. It is proven4,[9][10][11][12] also by our results that combination of these two methods gives optimal results in diagnostics of both PBTs as well as ultrasound guided in both unifocal and multifocal tumors. FNA allows rapid onsite evaluation, which is T A B L E 5 Selected literature data concerning palpable and nonpalpable breast lesions…”

The value of systematic pattern analysis in FNAC of breast lesions: 225 cases with cytohistological correlation

“…The statistical values indicating the diagnostic efficacies of the present study is well comparable to other studies [ Table 4 ]. [ 1 23 – 25 ]…”

Idiopathic granulomatous mastitis: a great imitator?

“…Therefore, it is important that thorough investigation is performed through a fine needle aspiration or biopsy to exclude all possible causes and to set the right diagnosis. In a large study with 2053 patients to identify infiltrating breast lesion, the sensitivity of fine needle aspiration under ultrasound guidance was 95%, the specificity 86% with a positive predicting value of 0.86 and a negative predicting value of 0.73 12. Corticosteroids are the first line of treatment if possible in combination with methotrexate as low doses of methotrexate have a corticosteroid-sparing effect 4 7 10 13.…”