The impact of core-biopsy on pre-operative diagnosis rate of screen detected breast cancers

Zorić

et al. 2016

acc

SUMMARY -Breast cancer is the most frequently diagnosed cancer and the leading cause of death from cancer in women. Th e accuracy of diagnosis can be increased with a combination of clinical examination, imaging diagnostics, and fi ne needle aspiration cytology (FNAC) or core needle biopsy, also known as triple test. Th e aim of the study was to evaluate the sensitivity and specifi city of FNAC in the diagnosis of breast tumors in our institution by correlating it with histopathology fi ndings. We assessed the accuracy of 124 FNAC fi ndings by comparing cytological diagnosis of breast masses with the diagnoses from histopathology reports obtained by surgery. Statistical analysis showed 95.1% accuracy, 97.7% sensitivity, 89.1% specifi city, 95.5% positive predictive value and 94.2% negative predictive value of FNAC. Study results indicated that FNAC could be used as a highly reliable tool in the diff erential diagnosis of breast tumors, in combination with clinical and imaging fi ndings, especially in developing countries with limited fi nancial resources.

Section: Discussionmentioning

confidence: 99%

Diagnostic Value of Fine Needle Aspiration Cytology for Breast Tumors

Zorić

et al. 2016

acc

Journal of Clinical Pathology

“…4 Centres that have converted to the use of core biopsies in screening practice have reported a significant rise in preoperative diagnosis rates from 72% to 90%, which implies a worthwhile improvement in management of screen detected breast cancer. 2 There are few comparative data on symptomatic breast practice.…”

Section: Discussionmentioning

confidence: 99%

Conversion to core biopsy in preoperative diagnosis of breast lesions: is it justified by results?

Shannon

Douglas-Jones²,

Dallimore³

2001

Aims-In recent years there has been increased use of core biopsy for the preoperative diagnosis of screen detected and symptomatic breast lesions. The aim of this study was to compare the quality assessment parameters for preoperative diagnosis by fine needle aspiration cytology (FNAC) before conversion to core biopsy with those for core biopsy after conversion in screening and symptomatic practice. Accuracy of typing and grading of tumours on core biopsy was assessed. Methods-Correlation of FNAC (C1-5) and core biopsy (B1-5) results (total of 1768 cases) with subsequent available resection histology was performed for 473 FNAC samples in 1997/98, 349 core biopsies in 1998/99 performed in symptomatic practice, for 561 FNAC samples in 1997/98, and 385 core biopsies in 1998/99 performed in screening. Quality assessment parameters were calculated using the methodology detailed in the National Health Service Breast Screening Programme guidelines for cytology practice. Results-Increased absolute and complete specificity, lower inadequate rates, and lower suspicious rates were found for core biopsy compared with FNAC in both symptomatic and screening practice. Typing of tumours was attempted in 86.7% of core biopsies in symptomatic practice and was accurate in 93.6% (132 of 141 where type was stated). Grading of tumours was attempted in 63.5% of invasive carcinomas, with the provisional grade on core biopsy being confirmed on later histology in 75% of grade 1 cases, in 70% of grade 2 cases, and in 86% of grade 3 cases. No case provisionally graded as 1 was subsequently found to be grade 3 and no provisionally grade 3 case was found to be grade 1. Conclusion-Conversion to core biopsy for the preoperative diagnosis of breast lesions increases specificity and reduces inadequate and suspicious rates. Grading and typing of tumours and assessment of oestrogen receptor status by immunocytochemistry is also possible in core biopsy, thereby increasing diagnostic information available when considering treatment options. (J Clin Pathol 2001;54:762-765)

“…The PPV when lobular neoplasia was combined with ADH was 61.5%, but the number of cases 3 Of the benign outcome, LCIS was the final diagnosis in 4 ALH (25%) and 8 in LCIS (47%) diagnosed on NCB. 4 Benign outcome of FE lesions included 17 benign phyllodes tumor and 1 borderline phyllodes.…”

mentioning

confidence: 95%

Characterization and outcome of breast needle core biopsy diagnoses of lesions of uncertain malignant potential (B3) in abnormalities detected by mammographic screening

Rakha

Lee

Jenkins

et al. 2011

Intl Journal of Cancer

In the setting of breast cancer screening, 5-9% of needle core biopsies are diagnosed as lesions of uncertain malignant potential (B3). The management of these lesions is potentially problematic as the data on their outcome remains limited. In our study, we aim to assess the outcome of screen-detected lesions diagnosed as B3 in a large series to validate previous studies and to characterize the malignant lesions detected after a B3 diagnosis. Therefore, the results of 1,025 needle core biopsies of women screened over a 7-year period (1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006) in two different regions in the UK with B3 diagnoses who underwent surgical excision were reviewed and compared to the final excision histology. Final histology showed that 25% of cases were malignant (17% ductal carcinoma in situ and 8% invasive). Predictors of malignancy included calcification on imaging and epithelial atypia on needle core biopsy particularly atypical ductal hyperplasia [positive predictive value 50%]. Pure flat epithelial atypia showed the lowest positive predictive value amongst all epithelial atypia groups (21%). The positive predictive value was low for complex sclerosing lesions (9%) and papillary lesions (13%) without epithelial atypia. Malignant tumors detected after B3 diagnosis showed favorable histological features, the majority were in situ, and most belonged to the low grade breast neoplasia family that is associated with indolent behavior. The underlying radiological abnormality was calcification in 44% of cases and the imaging classification was malignant/suspicious in 38%. In conclusion, our results further emphasize the heterogeneity of B3 lesions and that the likelihood of malignancy varies substantially between different histological subtypes. Malignancy is particularly associated with epithelial atypia suggesting the use of two categories of with and without epithelial atypia. Radiological findings provided useful information regarding the nature and outcome of B3 lesions.