Content area
Full Text
Since Bolmgren et al 1 introduced stereotactic needle biopsy of the breast in the late 1970s, and the introduction of automated core biopsy guns in the mid 1990s, needle core biopsy (NCB) has become an increasingly important diagnostic tool in the assessment of both palpable and non-palpable breast lesions. 2 3 NCB is now considered the method of choice for tissue sampling as part of the triple assessment of breast disease, 4 and the published data suggest that the use of core biopsy has increased the preoperative diagnosis rate in screen detected breast cancers. 5 6 NCB, as compared to preoperative fine needle aspiration biopsy, can reliably distinguish between in-situ and invasive cancers, allow evaluation of more histological, prognostic, and predictive factors in breast cancer, and provide ample tissue for ancillary testing such as immunohistochemical studies (IHC), DNA and RNA analysis and other molecular techniques. In some patients with breast cancer, for example those treated with preoperative chemotherapy, the NCB specimen might be the only pretreatment tissue sample available for studies of prognostic and predictive markers. Moreover, NCB specimens can be evaluated easily by histopathologists to whom H&E stained sections are familiar. 7
NCB can be performed either freehand or with image guidance. Initial use of image guided NCB was reported with the utilisation of stereotactic imaging and extended to ultrasound-guided biopsies that facilitated biopsy of the clinically occult lesions. These biopsy specimens can be collected with automated (spring-activated) needle core or vacuum assisted biopsy device. However, the biopsy method used depends on which modality best depicts the abnormality, location and size of the abnormality within the breast, patient factors, and the operator's experience and preference.
DIAGNOSTIC ACCURACY OF NCB
The diagnostic accuracy of NCB has been intensely verified and several studies have shown good concordance between NCB and subsequent surgical excision biopsy for diagnosis of carcinoma (ranging from 91% to 100%). 7 - 13 The sensitivity for detection of malignancy is high in the majority of published studies (85-100%) and specificity is 96-100% for stereotactically guided NCB, 8 14 - 19 although a few studies have shown a lower rate of sensitivity (eg 71% 20 ) and specificity (eg 85% 21 ). Slightly better results were documented in ultrasound-guided NCB and vacuum-assisted biopsies...