Abstract
For the evaluation of non-palpable lesions of the breast, image-guided large-core needle biopsies are increasingly replacing needle-localized open breast biopsies. In this study, the diagnostic accuracy of this minimally invasive technique was evaluated by reviewing the available literature. Five cohort studies were included in a meta-analysis. Sensitivity rate, histological agreement between needle biopsy and subsequent surgery or long-term mammographic follow-up and clinical consequences for different disease prevalences were assessed. The sensitivity rate of large-core needle biopsy for the diagnosis of breast cancer was high (97%). The reclassified agreement rate between core biopsy and subsequent surgical biopsy or long-term mammographic follow-up was also high (94%). In case of 20% breast cancer prevalence among women referred after screening (as in the US), the risk of breast cancer despite benign large-core needle biopsy result is less than 1%. In European countries, however, prevalence of breast cancer among referred women is 60–70%. This would result in a risk of breast cancer despite benign large-core needle biopsy result of 4–6%. The results of this meta-analysis indicate that the image guided large-core needle biopsy is a promising alternative for the needle localized breast biopsy. However, additional research is needed to explore the limiting factors of the technique. Without such detailed knowledge, a benign histological diagnosis on large-core needle biopsy in countries with high prevalence of malignancy among referred women should be interpreted with caution. © 2000 Cancer Research Campaign
Similar content being viewed by others
Article PDF
Change history
16 November 2011
This paper was modified 12 months after initial publication to switch to Creative Commons licence terms, as noted at publication
References
Achuthan R, Parkin G and Horgan K (1999) Screening mammography for women starting hormone replacement therapy. Lancet 353: 1855
Altman DG (1991) Comparing groups–categorical data. In: Practical Statistics for Medical Research, Altman DG, pp. 229–272. Chapman and Hall: London
Beemsterboer PMM, Warmerdam PG, Boer R and Koning de HJ (1998) Radiation risk of mammography related to benefit in screening programmes: a favourable balance?. J Med Screen 5: 81–87
Brown TA, Wall JW, Christensen ED, Smith DV, Holt CA, Carter PL, Patience TH, Babu SS and Williard W (1998) Atypical hyperplasia in the era of stereotactic core needle biopsy. J Surg Oncol 67: 168–173
Burbank F and Parker SH (1998) Methods for evauating the quality of an image-guided breast biopsy program. Semin Breast Dis 1: 71–83
Cyrlak D (1988) Induced costs of low-cost screening mammography. Radiology 168: 661–663
Dronkers DJ (1992) Stereotaxic core biopsy of breast lesions. Radiology 183: 631–634
Elvecrog EL, Lechner MC and Nelson MT (1993) Nonpalpable breast lesions: correlation of stereotaxic large-core needle biopsy and surgical biopsy results. Radiology 188: 453–455
Fracheboud J, Koning de HJ, Beemsterboer PMM, Boer R, Hendriks JHCL, Verbeek ALM, Ineveld v BM, Bruyn de AE and Maas van der PJ (1998) Nationwide breast cancer screening in The Netherlands: results of initial and subsequent screening 1990–1995. Int J Cancer 75: 694–698
Fuhrman GM, Cederbom GJ, Bolton JS, King TA, Duncan JL, Champaign JL, Smetherman DH, Farr GH, Kuske RR and McKinnon WM (1998) Image-guided core-needle breast biopsy is an accurate technique to evaluate patients with nonpalpable imaging abnormalities. Ann Surg 227: 932–939
Gadzala DE, Cederbom GJ, Bolton JS, McKinnon WM, Farr GH, Champaign J, Ordoyne K, Chung K and Fuhrman GM (1997) Appropriate management of atypical ductal hyperplasia diagnosed by stereotactic core needle breast biopsy. Ann Surg Oncol 4: 283–286
Gisvold JJ, Goellner JR, Grant CS, Donohue JH, Sykes MW, Karsell PR, Coffey SL and Sin-ho J (1994) Breast biopsy: a comparative study of stereotaxically guided core and excisional techniques. Am J Radiol 162: 815–820
Grodstein F, Stampfer MJ and Colditz GA (1997) Postmenopausal hormone therapy and mortality. N Engl J Med 336: 1769–1775
Irwig L, Tosteson ANA, Gatsonis C, Lau J, Colditz G, Chalmers TC and Mosteller F (1994) Guidelines for meta-analyses evaluating diagnostic tests. Ann Intern Med 120: 667–676
Jackman RJ, Nowels KW, Rodriguez-Soto J, Marzoni FA, Finkelstein SD and Shephard MJ (1999) Stereotactic, automated, large-core needle biopsy of nonpalpable breast lesions: false-negative and histologic underestimate rates after long-term follow up. Radiology 210: 799–805
Laya MB, Larson EB, Taplin SH and White E (1996) Effect of estrogen replacement therapy on the specificity and sensitivity of screening mammography. J Natl Cancer Inst 88: 643–649
Lee CH, Egglin TK, Philpotts LE, Mainiero MB and Tocino I (1997) Cost-effectiveness of stereotactic core needle biopsy: analysis by means of mammographic finding. Radiology 202: 849–854
Liberman L, Cohen MA, Dershaw DD, Abramson AF, Hann LE and Rosen PP (1995) Atypical ductal hyperplasia diagnosed at stereotaxic core biopsy of breast lesions; an indication for surgical biopsy. Am J Radiol 164: 1111–1113
Liberman L, Dershaw DD, Glassman JR, Abramson AF, Morris EA, LaTrenta LR and Rosen PP (1997) Analysis of cancers not diagnosed at stereotactic core breast biopsy. Radiology 203: 151–157
Marshall LM, Hunter DJ, Connolly JL, Schnitt SJ, Byrne CB, London SJ and Colditz GA (1997) Risk of breast cancer associated with atypical hyperplasia of lobular and ductal types. Cancer Epidemiol Biomarkers Prev 6: 297–301
Mikhail RA, Nathan RC, Weiss M, Tummala RM, Mullangi UR, Lawrence L and Mukkamala A (1994) Stereotactic core needle biopsy of mammographic breast lesions as a viable alternative to surgical biopsy. Ann Surg Oncol 1: 363–367
Moore MM, Hargett CW, Hanks JB, Fajardo LL, Harvey JA, Frierson HF and Slingluff CL (1997) Association of breast cancer with the finding of atypical ductal hyperplasia at core breast biopsy. Ann Surg 225: 726–733
Opie H, Estes NC, Jewell WR, Chang CHJ, Thomas JA and Estes MA (1993) Breast biopsy for nonpalpable lesions: a worthwhile endeavor? Am Surg 59: 490–494
Page DL, Jensen RA and Simpson JF (1998) Premalignant and malignant disease of the breast: the roles of the pathologist. Mod Pathol 11: 120–128
Parker SH (1994) Percutaneous large core breast biopsy. Cancer 74: 256–262
Parker SH, Lovin JD, Jobe WE, Burke BJ, Hopper KD and Yakes WF (1991) Nonpalpable breast lesions: stereotactic automated large-core biopsies. Radiology 180: 403–407
Pijnappel RM, Dalen van A, Borel Rinkes IHM, Tweel van den JG and Mali WPThM (1997) The diagnostic accuracy of core biopsy in palpable and non-palpable breast lesions. Eur J Radiol 24: 120–123
Rubin E, Dempsey PJ, Pile NS, Bernreuter WK, Urist MM, Shumate CR and Maddox WA (1995) Needle-localization biopsy of the breast: impact of a selective core needle biopsy program on yield. Radiology 195: 627–631
Tavassoli FA (1998) Ductal carcinoma in situ: introduction of the concept of ductal intraepithelial neoplasia. Mod Pathol 11: 140–154
Teh WL, Evans AJ and Wilson ARM (1998) Definitive non-surgical breast diagnosis: the role of the radiologist. Clin Radiol 53: 81–84
UK Trial of Early Detection of Breast Cancer Group (1999) 16-year mortality from breast cancer in the UK Trial of Early Detection of Breast Cancer. Lancet 353: 1909–1914
Velanovich V, Lewis FR, Nathanson SD, Strand VF, Talpos GB, Bhandarkar S, Elkus R, Szymanski W and Ferrara JJ (1999) Comparison of mammographically guided breast biopsy techniques. Ann Surg 229: 625–633
Author information
Authors and Affiliations
Rights and permissions
From twelve months after its original publication, this work is licensed under the Creative Commons Attribution-NonCommercial-Share Alike 3.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/3.0/
About this article
Cite this article
Verkooijen, H., Peeters, P., Buskens, E. et al. Diagnostic accuracy of large-core needle biopsy for nonpalpable breast disease: a meta-analysis. Br J Cancer 82, 1017–1021 (2000). https://doi.org/10.1054/bjoc.1999.1036
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1054/bjoc.1999.1036
Keywords
This article is cited by
-
Systematic tissue collection during clinical breast biopsy is feasible, safe and enables high-content translational analyses
npj Precision Oncology (2021)
-
A comparison of diagnostic performance of vacuum-assisted biopsy and core needle biopsy for breast microcalcification: a systematic review and meta-analysis
Irish Journal of Medical Science (1971 -) (2018)
-
MR-guided vacuum-assisted breast biopsy of MRI-only lesions: a single center experience
European Radiology (2016)
-
Accuracy of 16/18G core needle biopsy for ultrasound-visible breast lesions
World Journal of Surgical Oncology (2014)
-
Histological grade concordance between diagnostic core biopsy and corresponding surgical specimen in HR-positive/HER2-negative breast carcinoma
British Journal of Cancer (2014)