Ultrasound-guided Biopsy of Solid Breast Lesions: Should Fine-needle Aspiration be Replaced by Core Biopsy?
WS Mak, CY Fong, CY Lui
Hong Kong J Radiol 2012;15:10-4
Objective: To compare the outcome of fine-needle aspiration and core biopsy of solid breast lesions under ultrasound guidance and to evaluate if fine-needle aspiration should be replaced by core biopsy.
Methods: This retrospective review was conducted at Kwong Wah Hospital, Hong Kong from 1 January 2007 to 31 December 2009. All women with sonographically detected solid breast lesions who underwent both ultrasoundguided fine-needle aspiration and core biopsy for the same lesion were included in this study. The pathological diagnosis, tissue insufficiency rate, and the need of further intervention, such as vacuum-assisted biopsy or surgical excision, were directly compared for the two methods of tissue sampling.
Results: Regarding the 208 breast lesions biopsied, the specimen insufficiency rate was 16% (n = 34) for fineneedle aspiration and 2% (n = 4) for core biopsy. A total of 26 patients (13%) had a discordant pathological diagnosis between the two types of biopsy. Among these 26 discordant results, core biopsy was more accurate than fine-needle aspiration in nearly all cases (n = 25, 96%), and such discrepancies could be further categorised into fine-needle aspiration under-call (6/25, 24%) or over-call (19/25, 76%). The overall fine-needle aspiration undercall rate was 3% (6/208), while the over-call rate was 9% (19/208). All the 19 fine-needle aspiration over-call cases were benign, based on subsequent vacuum-assisted biopsy, surgical excision, or conservative management with clinical or sonographic follow-up. On the other hand, all the six fine-needle aspiration under-call lesions were deemed to require operative treatment by subsequent pathology results (5 were confirmed carcinomas and 1 was proven to be atypical ductal hyperplasia).
Conclusion: Core biopsy of solid breast lesions offered many advantages over fine-needle aspiration under ultrasound guidance, including a lower specimen insufficiency rate, lower false-positive and false-negative rates, and less need for subsequent interventions such as vacuum-assisted biopsy and / or surgical excision to achieve a definitive diagnosis. It is therefore recommended that in clinical practice, ultrasound-guided fine-needle aspiration should be replaced by core biopsy. By this means it should be possible to reach a more definitive diagnosis and better patient care, in terms of minimising anxiety and the potential risks of further invasive diagnostic procedures such as vacuum-assisted biopsy and surgical excision.
中文摘要
乳房實質病灶的超聲導引活檢：是否應該讓粗針組織切片代替 細針穿刺細胞學檢查？
麥詠詩、方俊仁、呂振英
目的：比較使用超聲導引細針穿刺細胞學檢查（FNA）及粗針組織切片（CB）對於乳房實質病灶組 織取樣的結果，以及評估應否讓CB代替FNA。
方法：本研究回顧從2007年1月1日至2009年12月31日期間，所有因乳房實質病灶而於香港廣華醫院 進行超聲導引FNA及CB的病人。比較使用兩種組織取樣的方法對於相同病灶在以下幾方面的不同之 處：病理學診斷、組織不足率、是否需要依賴如真空輔助切片或手術切除的方法來進一步確診。
結果：研究期間共進行了208次乳房灶活檢，FNA的組織不足率為16%（34例），CB的則為2%（4 例）。兩種組織取樣的方法下，有26位患者（13%）的病理學診斷結果不符合，其中CB的準確度 較FNA高，前者準確度達至96%（25例）。再仔細分析可以把這25例分為FNA診斷不足（6例， 24%）及FNA過度診斷（19例，76%）。總FNA診斷不足率為3%（6/208），FNA過度診斷率為9% （19/208）。其後真空輔助切片、手術切除、或者是臨床或超聲跟進結果顯示全部FNA過度診斷的 腫瘤均為良性。此外，根據其後病理學結果，FNA診斷不足的6例需進行手術治療，其中5例確診為 癌細胞，另1例為非典型乳管增生。
結論：對於乳房實質病灶，CB比FNA優勝，原因包括CB有較低的組織不足率，較低的假陽性和假 陰性結果，以及較少機會依賴其他確診方法如真空輔助切片及／或手術切除。所以臨床上應以CB代 替FNA，以減少病人憂慮及對其他方法的依賴（如真空輔助切片及／或手術切除），得到更明確的 診斷及提供更佳的醫護服務。