Stereotactic Large Core Needle Biopsy for All Nonpalpable Breast Lesions?

Abstract

SummaryBackground. Stereotactic large-core needle biopsy (SLCNB) is a minimally invasive method for histological diagnosis of nonpalpable breast disease. We studied differences in cancer prevalence between a group of women referred through the national screening program and a non-screening group, and assessed whether the validity of SLCNB differed between these groups.Methods. A group of non-selective, consecutive patients presenting with a nonpalpable mammographic lesion, who participated in a recently conducted multicenter study regarding the accuracy of SLCNB in The Netherlands, were the basis for this study. Prevalence of carcinoma, predictive value of a benign diagnosis, sensitivity, and specificity rate of SLCNB were compared between the two groups.Results. Of the 1029 lesions in 972 patients included, 858 were evaluable. In 850/858 lesions (99.1%) the reason for referral was clear. The prevalence of cancer in the screening group (n = 511 lesions) was 64.0% (95%CI 59.8-68.2), versus 49.6% in the non-screening group (n = 339) (95%CI 44.2-54.9). Respective predictive values of a benign diagnosis on SLCNB were 97.0 versus 94.8% (non-significant). The sensitivity rates of SLCNB were 98.5% (screening; 95%CI 96.5-99.5) versus 95.2% (non-screening; 95%CI 90.8-97.9). Specificity rates were 97.8 (95%CI 94.5-99.4) and 99.4% (95%CI 96.8-100), respectively.Conclusion. Despite a significant difference in the prevalence of carcinoma, the accuracy of SLCNB did not show a statistically significant difference between both patient groups. Therefore, SLCNB appears accurate in diagnosing nonpalpable breast lesions both in screening and non-screening patient groups.

Diagnostic performance of stereotactic large core needle biopsy for nonpalpable breast lesions in routine clinical practice

“…In the United States this number varies between 10 and 20% 7. In a situation with a minimally invasive, highly accurate diagnostic test, more biopsies might be performed for less suspicious lesions which may have an impact on the diagnostic performance of LCNB 4, 5, 8. However, when referral criteria are too stringent, more carcinomas will be missed which decreases the efficacy of a breast cancer screening.…”

Is Stereotactic Large-Core Needle Biopsy Beneficial Prior to Surgical Treatment in BI-RADS 5 Lesions?

“…Therefore, in practice, the prevalence of cancer in the subgroups should be assessed. This may differ according to background of referral of the patient (e.g., a higher cancer prevalence in patients referred through the national screening program compared to women visiting a breast cancer clinic for another reason) [15], type of hospital (e.g., a higher cancer prevalence in specialized cancer centers) or between countries (e.g., a higher cancer prevalence in Europe compared to the USA since the threshold for referral of malignancies in women with a suspicious nonpalpable breast lesion is lower in the USA) [16].…”

How Reliable Are Gene Expression-Based and Immunohistochemical Biomarkers Assessed on a Core-Needle Biopsy? A Study of Paired Core-Needle Biopsies and Surgical Specimens in Early Breast Cancer

“…Minimally invasive tumor biopsies are vital in the preoperative workup of breast lesions. Obtaining a preoperative core-needle biopsy (CNB) on suspected breast lesions is a standard procedure in the primary evaluation of breast cancer and can be used to accurately differentiate invasive disease from in situ lesions with a high sensitivity and specificity [ 1 , 2 , 3 , 4 , 5 , 6 , 7 ]. Neoadjuvant systemic treatment which is administered before definitive breast surgery is also becoming more widely implemented for a significant number of patients diagnosed with primary breast cancer since it offers the possibility of breast conservation by downsizing, without compromising prognosis [ 8 , 9 ].…”