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2017 | 17 | 71 | 267–274
Article title

Fine-needle versus core-needle biopsy – which one to choose in preoperative assessment of focal lesions in the breasts? Literature review

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Title variants
PL
Biopsja celowana cienkoigłowa i biopsja gruboigłowa – którą wybrać w przedoperacyjnej ocenie zmian ogniskowych w piersiach? Przegląd piśmiennictwa
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EN
Abstracts
EN
Aim: The aim of the study was to review two techniques that can be used to verify focal lesions in the breasts: fine-needle aspiration biopsy and core-needle biopsy. Material and methods: Fifty-five articles (original papers and reviews), half of them published within the past 5 years, were included in the analysis. The authors also took their own experience into account. Results: Pre-operative assessment of focal lesions in the breasts is crucial in the planning of further therapeutic management. The role of fine-needle aspiration biopsy has been reduced lately due to its low sensitivity and specificity as well as a high rate of non-diagnostic, suspicious and false negative results. This method does not enable one to differentiate between in situ and invasive disease. Currently, fine-needle biopsy is recommended for cystic lesions, suspected of being recurrences in the chest wall, and lymph node metastases. Core-needle biopsy is the basic diagnostic method of breast lesions. According to the recommendations of the Polish Ultrasound Society and American College of Radiology, BIRADS 4 and 5 lesions should be evaluated histopathologically. Core-needle biopsy makes it possible to establish a final diagnosis more frequently than fine-needle biopsy, both in the case of benign and malignant lesions. It delivers more information about the nature of a tumor (mutation of HER-2, estrogen and progesterone receptors and Ki-67 index). Its limitations include: underestimation of invasion and failure to recognize the components of ductal carcinoma in situ in papillary and atypical lesions. Single fine-needle aspiration biopsy is inexpensive, but when considering the cost of further diagnosis due to non-diagnostic, suspicious and atypical results, this method generates high additional costs. Conclusions: Microscopic verification of focal breast lesions is crucial for further therapeutic decisions. It has been proven that histopathological verification is more accurate and has more advantages than cytological assessment.
PL
Cel pracy: Celem pracy było przedstawienie dwóch technik weryfikacji zmian ogniskowych w piersiach: biopsji aspiracyjnej celowanej cienkoigłowej i biopsji gruboigłowej. Materiał i metody: Analizie poddano 55 artykułów (prac oryginalnych i przeglądowych), z których prawie połowa została opublikowana w ciągu ostatnich 5 lat. Autorzy uwzględnili również własne doświadczenia. Wyniki: Przedoperacyjna ocena zmian ogniskowych w piersiach jest niezbędna w planowaniu postępowania terapeutycznego. W ostatnim czasie rola biopsji aspiracyjnej cienkoigłowej celowanej uległa zmniejszeniu ze względu na niską czułość i swoistość, jak również wysoki odsetek wyników niediagnostycznych, podejrzanych i fałszywie ujemnych. Metoda ta nie pozwala na różnicowanie pomiędzy nowotworem in situ a inwazyjnym. Obecnie biopsja cienkoigłowa jest rekomendowana w przypadku zmian płynowych, podejrzanych o wznowę w ścianie klatki piersiowej oraz przerzutów do węzłów chłonnych. Biopsja gruboigłowa jest podstawową metodą diagnostyczną zmian w piersiach. Zgodnie z zaleceniami Polskiego Towarzystwa Ultrasonograficznego i American College of Radiology zmiany kategorii 4 i 5 według klasyfikacji BIRADS powinny zostać poddane weryfikacji histopatologicznej. Biopsja gruboigłowa pozwala na postawienie ostatecznej diagnozy częściej niż biopsja cienkoigłowa zarówno w przypadku zmian łagodnych, jak i złośliwych; dostarcza więcej informacji o charakterze guza (obecność mutacji HER-2, receptorów progesteronowych i estrogenowych oraz wskaźnika Ki-67). Do jej ograniczeń zalicza się niedoszacowanie inwazji oraz nierozpoznawanie komponentów raka przewodowego in situ w zmianach brodawkowatych i atypowych. Cena pojedynczej biopsji aspiracyjnej celowanej cienkoigłowej jest niewielka, jednak po uwzględnieniu kosztów dalszej diagnostyki wyników niediagnostycznych, podejrzanych i atypowych metoda ta generuje wysokie koszty dodatkowe. Wnioski: Weryfikacja mikroskopowa zmian ogniskowych w piersiach jest kluczowa w podejmowaniu dalszych decyzji terapeutycznych. Udowodniono, że weryfikacja histopatologiczna jest dokładniejsza i ma więcej zalet niż ocena cytologiczna. Artykuł w wersji polskojęzycznej jest dostępny na stronie http://jultrason.pl/index.php/issues/volume-17-no-71
Discipline
Publisher

Year
Volume
17
Issue
71
Pages
267–274
Physical description
Contributors
  • Department of Ultrasonography and Mammography, Mazovia Brodnowski Hospital, Warsaw, Poland
  • Department of Ultrasonography and Mammography, Mazovia Brodnowski Hospital, Warsaw, Poland
  • Department of Pediatric Rheumatology, Clinical Center, Faculty of Medicine, University of Nis, Serbia
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article
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