Ultrasound-guided Biopsy of Solid Breast Lesions: Should Fine-needle Aspiration be Replaced by Core Biopsy?

Full Article

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.



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?


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。