Percutaneous core biopsy of the breast: effect of operator experience and number of samples on diagnostic accuracy.
Author(s): Brenner RJ, Fajardo L, Fisher PR, Dershaw DD, Evans WP, Bassett L, Feig S, Mendelson E, Jackson V, Margolin FR
Publication: AJR Am J Roentgenol, 1996, Vol. 166, Page 341-6
PubMed ID: 8553943 PubMed Review Paper? No
Purpose of Paper
This paper investigated the effects of core number, lesion characteristics, and operator experience on the diagnostic accuracy of benign and malignant breast lesions.
Conclusion of Paper
Overall, malignant and benign diagnostic accuracy increased with increasing number of biopsies. The sensitivity was higher for invasive cancer than for DCIS in malignant lesions, regardless of the number of cores examined. The diagnostic accuracy of the first core was highest for masses with or without calcifications but after 5 cores, was highest for biopsies with calcifications or focal asymmetries. As the operators gained experience, the accuracy of diagnosis increased such that fewer cores were necessary to obtain comparable diagnostic accuracy.
Studies
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Study Purpose
This study investigated the effects of core number, lesion characteristics, and operator experience on the diagnostic accuracy of benign and malignant breast lesions. Five CNB specimens collected with a 14-gauge needle and matched excisional specimens were obtained from 230 asymptomatic women following mammography at 9 different hospitals. Diagnosis of the CNB was compared with the diagnosis based on the surgical specimen.
Summary of Findings:
An accurate diagnosis was achieved using the first CNB in 83% (193 of 230) of cases and the rate of diagnostic accuracy increased with each additional biopsy. The overall diagnostic sensitivity of five biopsies for malignant and benign lesions was 96% (135 of 140) and 96% (70 of 73 cases), respectively; but the sensitivity of a single biopsy for was only 84% (123 of 141 cases) for malignant lesions and 79% (58 of 73 cases) for benign lesions. When all 5 biopsies were examined, the sensitivity for invasive cancer was 99% (128 of 129 cases) but the diagnostic sensitivity of the five biopsies for DCIS was only 67% (8 of 12 cases) with three of the missed cases being DCIS of the noncomedo subtype. Similarly, the diagnostic sensitivity of the first biopsy was 92% for invasive carcinoma but only 42% for DCIS. Diagnostic accuracy of the first core was highest for masses without calcification (96%) followed by those with calcifications (87%), but increased with increasing cores and after five cores was highest for biopsies with calcifications and focal asymmetries (both 100% after five biopsies). Although small lesions tended to need more cores to obtain an accurate diagnosis, the effect of lesion size was not significant. As the operator gained experience during the study, the accuracy of diagnosis increased such that fewer cores were necessary to obtain comparable diagnostic accuracy.
Biospecimens
Preservative Types
- None (Fresh)
- Formalin
Diagnoses:
- Neoplastic - Benign
- Neoplastic - Carcinoma
Platform:
Analyte Technology Platform Morphology Light microscopy Morphology X-ray Pre-analytical Factors:
Classification Pre-analytical Factor Value(s) Biospecimen Acquisition Method of tissue acquisition Staff performing tissue acquisition compared
Biospecimen Aliquots and Components Biospecimen heterogeneity Intratumoral sampling (exact positions not specified)
Preaquisition Diagnosis/ patient condition Invasive carcinoma
DCIS
Benign
Preaquisition Prognostic factor Non-calcified mass
Mass with calcification
Focal asymmetries
Architectural distortion
Calcification
2-100 mm lesion