Comparison of the diagnostic accuracy of fine needle aspiration cytology and core needle biopsy in patients with ultrasound detected breast lesions as well as the cost effectiveness of the screening modalities in the poor population visiting our institution

Nishi Tandon, Neema Tiwari, Tanya Tripathi, Amrisha Jaiswal, Nirupma Lal, Osman Musa


Background: Breast cancer is the leading cause of cancer relayed mortality and morbidity among women and the incidence of the disease is rising all over the world. Despite the imaging techniques, histopathological diagnosis still plays an essential role for differential diagnosis and for avoiding surgical over-treatment in case of breast lesions with suspicious features (10). Fine-needle aspiration cytology (FNAC), core needle biopsy (CNB) and vacuum assisted breast biopsy(VABB) represent the current methods of choice for pathological diagnosis, both with their specific advantages and limitations. The purpose of this study is to compare the diagnostic accuracy of FNAC and CNB in patients with US-detected breast lesions as well as the cost effectiveness of the screening modalities in the poor population visiting our institution.

Methods: It was a retrospective study done using the department register data where we compared the FNAC findings and compared it with CNB findings in the same cases. This was a short study done for a period of 3 months only from January 2017-March 2017. We collected 50 cases of breast carcinomas where both FNAC and CNB findings as well as the clinical information and follow up were available for the patients. We compiled the data for these cases and slides were reviewed by two independent pathologists to remove observer bias. Authors tabulated clinical information, FNAC diagnosis, CNB diagnosis as well as the stage at presentation and follow up for each case.

Results: As is seen in this study that 7 cases which were benign on FNAC were benign on CNB also. As for malignancy while CNB diagnosed 43 cases as malignant FNAC diagnosed 5 cases as suspicious [which were malignant on CNB] and 37 cases as malignant which came out to be malignant in CNB too. So, the while the NPV is 100% the PPV is comparable to CNB.

Conclusions: In conclusion, FNAC and CNB represent accurate methods for the characterization of US-detected breast nodules, with similar values of diagnostic accuracy, sensitivity, specificity and NPV. In experienced hands, FNAC could be still considered the first method to evaluate breast lesions being less invasive. CNB has a higher PPV and should be performed for uncertain diagnostic cases and when the evaluation of the invasiveness or histological type of breast lesion is mandatory.


Breast, CNB, FNA, Sensitivity, Specificity

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Vestito A, Mangieri FF, Gatta G, Moschetta M, Turi B, Ancona A. Breast carcinoma in elderly women. Our experience. G Chir. 2011;32(10):411-6.

Brenner RJ, Parisky Y. Alternative breast-imaging approaches. Radiol Clin North Am. 2007;45:907-23.

Kerlikowske K, Carney PA, Geller B, Mandelson MT, Taplin SH, Malvin K, et al. Performance of screening mammography among women with and without a first-degree relative with breast cancer. Ann Intern Med. 2000;133:855-63.

Lindfors KK, Boone JM, Nelson TR, Yang K, Kwan AL, Miller DF. Dedicated breast CT: initial clinical experience. Radiology. 2008;246:725-33.

Chan SW, Cheung PS, Chan S, Lau SS, Wong TT, Ma M, et al. Benefit of ultrasonography in the detection of clinically and mammographically occult breast cancer. World J Surg. 2008;32:2593-8.

Jochelson MS, Dershaw DD, Sung JS, Heerdt AS, Thornton C, Moskowitz CS, et al. Bilateral contrast-enhanced dual-energy digital mammography: feasibility and comparison with conventional digital mammography and MR imaging in women with known breast carcinoma. Radiology. 2013;266:743-51.

Weinstein S, Rosen M. Breast MR imaging: current indications and advanced imaging techniques. Radiol Clin North Am. 2010;48:1013-42.

Moschetta M, Telegrafo M, Capuano G, Rella L, Scardapane A, Angelelli G, et al. Intra-prosthetic breast MR virtual navigation: A preliminary study for a new evaluation of silicone breast implants. Magn Reson Imaging. 2013;31:1292-7.

Kalles V, Zografos GC, Provatopoulou X, Koulocheri D, Gounaris A. The current status of positron emission mammography in breast cancer diagnosis. Breast Cancer. 2013;20:123-30.

Capalbo E, Sajadidehkordi F, Colombi C, Ticha V, Moretti A, Peli M, et al. Revaluation of breast cytology with pathologist onsite of lesions with suspicious sonographic features. Eur J Radiol. 2013;82:1410-5.

Smith MJ, Heffron CC, Rothwell JR, Loftus BM, Jeffers M, Geraghty JG. Fine needle aspiration cytology in symptomatic breast lesions: still an important diagnostic modality? Breast J. 2012;18(2):103-10.

Berner A, Davidson B, Sigstad E, Risberg B. Fine-needle aspiration cytology vs. core biopsy in the diagnosis of breast lesions. Diagn Cytopathol. 2003;29(6):344-8.

Levy L, Suissa M, Chiche JF, Teman G, Martin B. BIRADS ultrasonography. Eur J Radiol. 2007;61(2):202-11.

Costantini M, Belli P, Lombardi R, Franceschini G, Mulè A, Bonomo L. Characterization of solid breast masses: use of the sonographic breast imaging reporting and data system lexicon. J Ultrasound Med. 2006;25(5):649-59.

Kirshenbaum K, Keppke A, Hou K, Dickerson M, Gajjar M, Kirshenbaum G. Reassessing specimen number and diagnostic yield of ultrasound guided breast core biopsy. Breast J. 2012;18(5):464-9.

Fishman JE, Milikowski C, Ramsinghani R, Velasquez MV, Aviram G. US-guided core-needle biopsy of the breast: how many specimens are necessary? Radiology. 2003;226(3):779-82.

Lazarus E, Mainiero MB, Schepps B, Koelliker SL, Livingston LS. BI-RADS lexicon for US and mammography: interobserver variability and positive predictive value. Radiology. 2006;239(2):385-91.

Ibrahim AE, Bateman AC, Theaker JM, Low JL, Addis B, Tidbury P, et al. The role and histological classification of needle core biopsy in comparison with fine needle aspiration cytology in the preoperative assessment of impalpable breast lesions. J Clin Pathol. 2001;54(2):121-5.

Hatada T, Ishii H, Ichii S, Okada K, Fujiwara Y, Yamamura T. Diagnostic value of ultrasound-guided fine-needle aspiration biopsy, core-needle biopsy, and evaluation of combined use in the diagnosis of breast lesions. J Am Coll Surg. 2000;190(3):299-303.

Barra Ade A, Gobbi H, de L Rezende CA, Gouvêa AP, de Lucena CE, Reis JH, et al. A comparision of aspiration cytology and core needle biopsy according to tumor size of suspicious breast lesions. Diagn Cytopathol. 2008;36(1):26-31.

Willems SM, van Deurzen CH, van Diest PJ. Diagnosis of breast lesions: fine-needle aspiration cytology or core needle biopsy? A review. J Clin Pathol. 2012;65(4):287-92.

Boerner S, Fornage BD, Singletary E, Sneige N. Ultrasoundguided fine-needle aspiration (FNA) of nonpalpable breast lesions: a review of 1885 FNA cases using the National Cancer Institute-supported recommendations on the uniform approach to breast FNA. Cancer. 1999;25;87(1):19-24.

Westenend PJ, Sever AR, Beekman-De Volder HJ, Liem SJ. A comparison of aspiration cytology and core needle biopsy in the evaluation of breast lesions. Cancer. 2001;93(2):146-50.

Provenzano E, Pinder SE. Pre-operative diagnosis of breast cancer in screening: problems and pitfalls. Pathology. 2009;41(1):3-17.