Can core needle biopsy replace fine-needle aspiration cytology in the diagnosis of palpable breast carcinoma. A comparative study of 124 women.

Abstract

There appears to be a growing movement in favor of core needle biopsy (CNB) over fine-needle aspiration (FNA) cytology in detecting breast carcinoma in women. The authors compared the sensitivity and specificity of these two methods in patients who presented to The University of Texas M. D. Anderson Cancer Center for evaluation of a palpable breast mass. One hundred and twenty-four women (mean age, 51 years; range, 28-86 years) with a clinically suspicious palpable mass (mean size, 4.4 cm; range, 1-12 cm) underwent concurrent FNA and CNB. For the FNA, an average of three needle passes were made. FNA was followed by three CNBs using the Bard Monopty needle. CNB samples were submitted for frozen section to determine adequacy, and an additional three cores were performed if the first batch was deemed inadequate. All patients ultimately had histologic confirmation of their neoplasms either by the core needle procedure or by definitive open surgical biopsy. Features of cases with discrepant diagnoses were examined in relation to tumor size and histologic type. Specificity of both FNA and CNB was 100%. The sensitivity in detecting a malignant neoplasm was higher for FNA than for CNB (97.5% vs. 90%, P < 0.004). In our experience, FNA of palpable breast lesions is a more sensitive method for the detection of carcinoma regardless of tumor type, size, or differentiation. Contrary to other reports, not only was FNA alone more sensitive than CNB alone, the addition of CNB to an already negative FNA failed to increase sensitivity in the detection of carcinoma. However, CNB did contribute to a more definitive diagnosis in some cases. The authors also found FNA to be more cost effective than CNB for palpable breast lesions when time and effort are taken into consideration. This reinforces the benefit of FNA over CNB in the detection of early stage breast carcinoma.