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

• Authors: Ewa Łukasiewicz , Agnieszka Ziemiecka , Wiesław Jakubowski , Jelena Vojinovic

Title variants

PL

Biopsja celowana cienkoigłowa i biopsja gruboigłowa – którą wybrać w przedoperacyjnej ocenie zmian ogniskowych w piersiach? Przegląd piśmiennictwa

• Languages of publication: 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

Keywords

EN

atypical ductalhyperplasia; core-needle biopsy; ductal carcinomain situ; fine-needle aspirationbiopsy; papillary lesions

Discipline

• MEDICINE: MEDICINE

• Publisher: Medical Communications
• Journal: Journal of Ultrasonography
• Year: 2017
• Volume: 17
• Issue: 71
• Pages: 267–274

Contributors

author

Ewa Łukasiewicz

• Department of Medical Imaging, Mazovia Brodnowski Hospital, Warsaw, Poland

author

Agnieszka Ziemiecka

• Department of Ultrasonography and Mammography, Mazovia Brodnowski Hospital, Warsaw, Poland

author

Wiesław Jakubowski

• Department of Ultrasonography and Mammography, Mazovia Brodnowski Hospital, Warsaw, Poland

author

Jelena Vojinovic

• Department of Pediatric Rheumatology, Clinical Center, Faculty of Medicine, University of Nis, Serbia

References

• 1. Domagała W: Diagnostyka zmian w piersi: biopsja aspiracyjna cienkoigłowa czy biopsja gruboigłowa? Komentarz. Medycyna Praktyczna – Onkologia 2010; 6: 13 (Tse GM, Tan PH: Diagnosing breast lesions by fine needle aspiration cytology or core biopsy: which is better? Breast Cancer Res Treat 2010; 123: 1–8).
• 2. Parker SH, Jobe WE, Dennis MA, Stavros AT, Johnson KK, Yakes WF et al.: US-guided automated large-core breast biopsy. Radiology 1993; 187: 507–511.
• 3. Tse GM, Tan PH: Diagnosing breast lesions by fine needle aspiration cytology or core biopsy: which is better? Breast Cancer Res Treat 2010; 123: 1–8.
• 4. Fishman JE, Milikowski C, Ramsinghani R, Velasquez MV, Aviram G: US-guided core-needle biopsy of the breast: how many speciments are necessary? Radiology 2003; 226: 779–782.
• 5. Nassar A: Core needle biopsy versus fine needle aspiration biopsy in breast – a historical perspective and opportunities in the modern era. Diagn Cytopathol 2011; 39: 380–388.
• 6. Willems SM, van Deurzen CHM, van Diest PJ: Diagnosis of breast lesions: Fine-needle aspiration cytology or core needle biopsy? J Clin Pathol 2012; 65: 287–292.
• 7. Hukkinen K, Kivisaari L, Heikkilä PS, Von Smitten K, Leidenius M: Unsuccessful preoperative biopsies, fine needle aspiration cytology or core needle biopsy, lead to increased costs in the diagnostic workup in breast cancer. Acta Oncol 2008; 47: 1037–1045.
• 8. Ballo MS, Sneige N: Can core needle biopsy replace fine-needle aspiration cytology in the diagnosis of palpable breast carcinoma. a comparative study of 124 women. Cancer 1996; 78: 773–777.
• 9. He Q, Fan X, Yuan T, Kong L, Du X, Zhuang D et al.: Eleven years of experience reveals that fine-needle aspiration cytology is still a useful method for preoperative diagnosis of breast carcinoma. Breast 2007; 16: 303–306.
• 10. Aker F, Gümrükçü G, Onomay BÇ, Erkan M, Gürleyik G, Kiliçoğlu G et al.: Accuracy of fine-needle aspiration cytology in the diagnosis of breast cancer a single-center retrospective study from Turkey with cytohistological correlation in 733 cases. Diagn Cytopathol 2015; 43: 978–986.
• 11. Bolívar AV, Alfonso-Bartolomé P, García EO, Ayensa FG: Ultrasound- -guided core needle biopsy of non-palpable breast lesions: a prospective analysis in 204 cases. Acta Radiol 2005; 46: 690–695.
• 12. Park SM, Lee DW, Jin SY, Kim DW, Jeen YM, Choi IH: Fine-needle aspiration cytology as the first pathological diagnostic modality in breast lesions: a comparison with core needle biopsy. Basic Applied Pathology 2010; 3: 1–6.
• 13. Zhang C, Lewis DR, Nasute P, Hayes M, Warren LJ, Gordon PB et al.: The negative predictive value of ultrasound-guided 14-gauge core needle biopsy of breast masses: a validation study of 339 cases. Cancer Imaging 2012; 12: 488–496.
• 14. Wood B, Junckernstorff R, Sterrett G, Frost F, Harvey J, Robbins P: a comparison of immunohistochemical staining for oestrogen receptors, progesterone receptors and HER-2 in breast biopsies and subsequent excisions. Pathology 2007; 39: 391–395.
• 15. Pisano ED, Fajardo LL, Tsimikas J, Sneige N, Frable WJ, Gatsonis CA et al.: Rate of insufficient samples for fine-needle aspiration for nonpalpable breast lesions in a multicenter clinical trial: The Radiologic Diagnostic Oncology Group 5 Study. The RDOG5 investigators. Cancer 1998; 82: 679–688.
• 16. Ibrahim AE, Bateman AC, Theaker JM, Low J, Addis B, Tidbuty P et al.: The role and histological classification of needle core biopsy in comparison with fine needle aspiration cytology in the preoperative assessment of impalpable breast lesions. J Clin Pathol 2001; 54: 121–125.
• 17. Lieske B, Ravichandran D, Wright D: Role of fine-needle aspiration cytology and core biopsy in the preoperative diagnosis of screen-detected breast carcinoma. Br J Cancer 2006; 95: 62–66.
• 18. Breast fine needle aspiration cytology and core biopsy: a guide for practice. National Breast Cancer Center, Camperdown 2004.
• 19. Park HL, Hong J: Vacuum-assisted breast biopsy for breast cancer. Gland Surg 2014; 3: 120–127.
• 20. Povoski SP, Jimenez RE, Wang WP: Ultrasound-guided diagnostic breast biopsy methodology: retrospective comparison of the 8-gauge vacu um-assisted biopsy approach versus the spring-loaded 14-gauge core biopsy approach. World J Surg Oncol 2011; 9: 87.
• 21. Darling ML, Smith DN, Lester SC, Kaelin C, Selland DL, Denison CM et al.: Atypical ductal hyperplasia and ductal carcinoma in situ as revealed by large-core needle breast biopsy: results of surgical excision. AJR Am J Roentgenol 2000; 175: 1341–1346.
• 22. Lee SK, Yang JH, Woo SY, Lee JE, Nam SJ: Nomogram for predicting invasion in patients with a preoperative diagnosis of ductal carcinoma in situ of the breast. Br J Surg 2013; 100: 1756–1763.
• 23. Park HL, Kwak JY, Jung H, Lee SH, Shim JY, Kim JY et al.: Is mammotome excision feasible for benign breast mass bigger than 3 cm in greatest dimension? J Korean Surg Soc 2006; 70: 25–29.
• 24. March DE, Coughlin BF, Barham RB, Goulart RA, Klein SV, Bur ME et al.: Breast masses: removal of all US evidence during biopsy by using handheld vacuum-assisted device – initial experience. Radiology 2003; 227: 549–555.
• 25. Park HL, Kim LS: The current role of vacuum assisted breast biopsy system in breast disease. J Breast Cancer 2011; 14: 1–7.
• 26. Kooistra B, Wauters C, Strobbe L: Indeterminate fine-needle aspiration: Repeat aspiration or core needle biopsy? Ann Surg Oncol 2009; 16: 281–284.
• 27. Hartmann LC, Radisky DC, Frost MH, Santen RJ, Vierkant RA, Benetti LL et al.: Understanding the premalignant potential of atypical hyperplasia through its natural history: a longitudinal cohort study. Cancer Prev Res (Phila) 2014; 7: 211–217.
• 28. Pinder SE, Ellis IO: The diagnosis and management of pre-invasive breast disease: Ductal carcinoma in situ (DCIS) and atypical ductal hyperplasia (ADH) – current definitions and classifications. Breast Cancer Res 2003; 5: 254–547.
• 29. Polat AK, Kanbour-Shakir A, Andacoglu O, Polat AV, Johnson R, Bonaventura M et al.: Atypical hyperplasia on core biopsy: is further surgery needed? Am J Med Sci 2012; 344: 28–31.
• 30. McGhan LJ, Pockaj BA, Wasif N, Giurescu ME, McCullough AE, Gray RJ: Atypical ductal hyperplasia on core biopsy: an automatic trigger for excisional biopsy? Ann Surg Oncol 2012; 19: 3264–3269.
• 31. Hsu HH, Yu JC, Hsu GC, Yu CP, Chang WC, Tung HJ et al.: Atypical ductal hyperplasia of the breast diagnosed by ultrasonographically guided core needle biopsy. Ultraschall Med 2012; 33: 447–454.
• 32. Mesurolle B, Perez JCH, Azzumea F, Lemercier E, Xie X, Aldis a et al.: Atypical ductal hyperplasia diagnosed at sonographically guided core needle biopsy: frequency, final surgical outcome, and factors associated with underestimation. AJR Am J Roentgenol 2014; 202: 1389–1394.
• 33. Zhao C, Desouki MM, Florea A, Mohammed K, Li X, Dabbs D: Pathologic findings of follow-up surgical excisions for lobular neoplasia on breast core biopsy performed for calcifications. Am J Clin Pathol 2012; 138: 72–78.
• 34. Murray MP, Luedtke C, Liberman L, Nehhozina T, Akram M, Brogi E: Classic lobular carcinoma in situ and atypical lobular hyperplasia at percutaneous breast core biopsy: Outcomes of prospective excision. Cancer 2013; 119: 1073–1079.
• 35. Jassem J, Krzakowski M, Bobek-Billewicz B, Duchnowska R, Jeziorski A, Olszewski w et al.: Rak piersi. Aktualizacja na dzień 03.12.2014. In: Krzakowski M, Warzocha K (eds.): Zalecenia postepowania diagnostyczno-terapeutycznego w nowotworach złośliwych – 2013 rok. Tom I. Via Medica, Gdańsk 2013.
• 36. Lesurf R, Aure MR, Mørk HH, Vitelli V; Oslo Breast Cancer Research Consortium (OSBREAC), Lundgren S et al.: Molecular features of subtype-specific progression from ductal carcinoma in situ to invasive breast cancer. Cell Rep 2016; 16: 1166–1679.
• 37. Leifland K, Lagerstedt U, Svane G: Comparison of stereotactic fine needle aspiration cytology and core needle biopsy in 522 non-palpable breast lesions. Acta Radiol 2003; 44: 387–391.
• 38. Brennan ME, Turner RM, Ciatto S, Marinovich ML, French JR, Macaskill P et al.: Ductal carcinoma in situ at core-needle biopsy: meta- -analysis of underestimation and predictors of invasive breast cancer. Radiology 2011; 260: 119–128.
• 39. Schulz S, Sinn P, Golatta M, Rauch G, Junkermann H, Schuetz F et al.: Prediction of underestimated invasiveness in patients with ductal carcinoma in situ of the breast on percutaneous biopsy as rationale for recommending concurrent sentinel lymph node biopsy. Breast 2013; 22: 537–542.
• 40. Caswell-Smith P, Wall M: Ductal carcinoma in situ: Is core needle biopsy enough? J Med Imaging Radiat Oncol 2017; 61: 29–33.
• 41. Park SH, Kim MJ, Kim SJ, Kim EK: Ductal carcinoma in situ diagnosed using an ultrasound-guided 14-gauge core needle biopsy of breast masses: can underestimation be predicted preoperatively? Ultrasonography 2014; 33: 128–135.
• 42. Lee SK, Yang JH, Woo SY, Lee JE, Nam SJ: Nomogram for predicting invasion in patients with a preoperative diagnosis of ductal carcinoma in situ of the breast. Br J Surg 2013; 100: 1756–1763.
• 43. Silverstein MJ, Skinner KA, Lomis TJ: Predicting axillary nodal positivity in 2282 patients with breast carcinoma. World J Surg 2001; 25: 767–772.
• 44. Masood S, Loya A, Khalbuss W: Is core needle biopsy superior to fine- -needle aspiration biopsy in the diagnosis of papillary breast lesions? Diagn Cythopatol 2003; 28: 329–334.
• 45. Lewis JT, Hartmann LC, Vierkant RA, Maloney SD, Shane Pankratz V, Allers TM et al.: An analysis of breast cancer risk in women with single, multiple, and atypical papilloma. Am J Surg Pathol 2006; 30: 665–672.
• 46. O’Malley F, Visscher D, MacGrogan G, Tan PH, Ichihara S: Intraductal papilloma. In: Lakhani SR, Ellis IO, Schnitt SJ, Tan PH, van de Vijer MJ (eds.): WHO classification of tumours of the breast. International Agency for Research on Cancer, Lyon 2012: 100–102.
• 47. Wiratkapun C, Keeratitragoon T, Lertsithichai P, Chanplakorn N: Upgrading rate of papillary breast lesions diagnosed by core-needle biopsy. Diagn Interv Radiol 2013; 19: 371–376.
• 48. Pareja F, Corben AD, Brennan SB, Murray MP, Bowser ZL, Jakate K et al.: Breast intraductal papilloma without atypia in radiologic-pathologic concordant core-needle biopsies: rate of upgrade to carcinoma at excision. Cancer 2016; 122: 2819–2827.
• 49. Rizzo M, Linebarger J, Lowe MC, Pan L, Gabram SG, Vasquez L et al.: Management of papillary breast lesions diagnosed on core-needle biopsy: clinical pathologic and radiologic analysis of 276 cases with surgical follow-up. J Am Coll Surg 2012; 214: 280–287.
• 50. Bianchi S, Bendinelli B, Saladino V, Vezzosi V, Brancato B, Nori J et al.: Non-malignant breast papillary lesions – b3 diagnosed on ultrasound- -guided 14-gauge needle core biopsy: Analysis of 114 cases from single institution and review of the literature. Pathol Oncol Res 2015; 21: 535–546.
• 51. Jakubowski W, Dobruch-Sobczak K, Migda B: Standards of the Polish Ultrasound Society – update. Sonomammography examination. J Ultrason 2012; 12: 245–261.
• 52. Choi J, Koo JS: Comparative study of histological features between core needle biopsy and surgical excision in phyllodes tumor. Pathol Int 2012; 62: 120–126.
• 53. Lawton TJ, Acs G, Argani P, Farshid G, Gilcrease M, Goldstein N et al.: Interobserver variability by pathologist in the distinction between cellular fibroadenomas and phylloides tumors. Int J Surg Pathol 2014; 22: 695–698.
• 54. Gruber R, Walter E, Helbich TH: Cost comparison between ultrasound- -guided 14-G large core breast biopsy and open surgical biopsy: an analysis from Austria. Eur J Radiol 2010; 74: 519–524.
• 55. Loughran CF, Keeling CR: Seeding of tumour cells following breast biopsy: a literature review. Br J Radiol 2011; 84: 869–874.

• Document Type: article