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Ultrasound-guided core needle biopsy of the breast: does frozen section give an accurate diagnosis?

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Abstract

Reducing the period of uncertainty between the discovery of a breast tumor and histological diagnosis alleviates the psychological impact of breast cancer to an important degree. We aimed to verify whether histological results obtained with frozen sections of core needle biopsies (CNBs) offer an accurate and reliable tool for minimising this period. In 2619 cases we compared histological diagnosis on frozen sections with those on paraffin sections of CNB and finally with the results of open biopsies. Of the cases 49% were proved malignant and 51% benign. In 99.3% of the malignant lesions preceding CNB was correctly classified as B5 (n = 1185, 92.9%) or at least B4 (n = 82, 6.4%) in frozen and in paraffin sections. There were seven false-negative cases in frozen (false-negative rate = 0.5%) and five false-negative cases (false-negative rate = 0.4%) in paraffin sections of CNB. On frozen sections complete sensitivity was 99.5% and the positive predictive value of B5 was 99.9%. There was one false-positive case in frozen sections and one in paraffin sections. False-positive rate = 0.08%, negative predictive value for B2 = 99.4% for frozen and 99.6% for paraffin sections; full specificity was 85.9 for frozen and 85.8 for paraffin sections of CNBs. Immediate investigation of CNB in frozen sections is an accurate diagnostic method and an important step in reducing psychological strain on patients with breast tumors and may be offered by specialised Breast Assessment Units.

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References

  1. Parker SH (1994) Percutaneous large core breast biopsy. Cancer 74:256–262

    Article  PubMed  CAS  Google Scholar 

  2. Parker SH, Jobe WE, Dennis MA, Stavros AT, Johnson KK, Yakes WF, Truell JE, Price JG, Kortz AB, Clark DG (1993) US-guided automated large-core breast biopsy. Radiology 187(2):507–511

    PubMed  CAS  Google Scholar 

  3. Parker SH, Burbank F, Jackman RJ, Aucreman CJ, Cardenosa G, Cink TM, Coscia JL Jr., Eklund GW, Evans WP 3rd, Garver PR et al (1994) Percutaneous large-core breast biopsy: a multi-institutional study. Radiology 193(2):359–364

    PubMed  CAS  Google Scholar 

  4. Usami S, Moriya T, Kasajima A, Suzuki A, Ishida T, Sasano H, Ohuchi N (2005) Pathological aspects of core needle biopsy for non-palpable breast lesions. Breast Cancer 12:272–278

    Article  PubMed  Google Scholar 

  5. Britton PD (1999) Fine needle aspiration or core biopsy. Breast 8:1–4

    Article  Google Scholar 

  6. Bulgaresi P, Cariaggi P, Ciatto S, Houssami N (2006) Positive predictive value of breast fine needle aspiration cytology (FNAC) in combination with clinical and imaging findings: a series of 2334 subjects wih abnormal cytology. Breast Cancer Res Treat 97:319–321

    Article  PubMed  CAS  Google Scholar 

  7. Farshid G, Pieterse S (2006) Core imprint cytology of screen-detected breast lesions is predictive of the histological results. Cancer (Cancer Cytopathol) 108:150–156

    Google Scholar 

  8. Jones L, Lott MF, Calder CJ, Kutt E (2004) Imprint cytology from ultrasound-guided core biopsies: accurate and immediate diagnosis in a one-step breast clinic. Clin Radiol 59(10):903–908

    Article  PubMed  CAS  Google Scholar 

  9. Klevesath MB, Godwin RJ, Bannon R, Munthali L, Coveney E (2005) Touch imprint cytology of core needle biopsy specimens: a useful method for immediate reporting of symptomatic breast lesions. Eur J Surg Oncol 31(5):490–494

    Article  PubMed  CAS  Google Scholar 

  10. Poole K, Lyne PA (2000) The ‘cues’ to diagnosis: describing the monitoring activities of women undergoing diagnostic investigations for breast disease. J Adv Nurs 31(4):752–758

    Article  PubMed  CAS  Google Scholar 

  11. Palsson M, Norberg A (1995) Breast cancer patients’ experiences of nursing care with the focus on emotional support: the implementation of a nursing intervention. J Adv Nurs 21(2):277–285

    PubMed  CAS  Google Scholar 

  12. Leinster S (1994) How I do it – breast cancer: the psychological management of the patient with early breast cancer. Eur J Surg Oncol 20(6):711–714

    PubMed  CAS  Google Scholar 

  13. Bauermeister DE (1980) The role and limitations of frozen section and needle aspiration biopsy in breast cancer diagnosis. Cancer 46:947–949

    Article  PubMed  CAS  Google Scholar 

  14. Gonzalez E, Grafton WD, Morris M, Barr L (1985) Diagnosing breast cancer using frozen sections from Tru-cutR needle biopsies. Six-year experience with 162 Biopsies, with emphasis on outpatient diagnosis of breast carcinoma. Ann Surg 202(6):696–701

    Article  PubMed  CAS  Google Scholar 

  15. Wells CA, The E.C. Working Group on Breast Cancer Screening Pathology: quality assurance guidelines for pathology (2006) Perry NM on behalf of the EUSOMA working party: multi-disciplinary aspects of quality assurance in the diagnosis of breast disease, 4th edn. European Commission, Luxembourg, p207, pp 232–234

  16. Österreichische Gesellschaft für Pathologie (2005) B-Klassifikation für Mamma Stanzbiopsien http.://www.pathology.at/b-klassifikation.htm. Cited 07 Dec 2006

  17. Wells CA, The E.C. Working Group on Breast Cancer Screening Pathology: quality assurance guidelines for pathology (2006) European Commission: European guidelines for quality assurance in breast cancer screening and diagnosis, 4th edn, pp 252–254

  18. Caruso ML, Gabrieli G, Marzullo G, Pirelli M, Rizzi E, Sorino F (1998) Core biopsy as alternative to fine-needle aspiration biopsy in diagnosis of breast tumors. Oncologist 3:45–49

    PubMed  Google Scholar 

  19. Ciatto S, Houssami N, Ambrogetti D, Bianchi S, Bonardi R, Brancato B, Catarzi S, Risso GR (2006) Accuracy and underestimation of malignancy of breast core needle biopsy: the Florence experience of over 4,000 consecutive biopies. Breast Cancer Res Treat [Oct 11, Epub ahead of print]

  20. Dillon MF, Hill ADK, Quinn CM, O’Doherty A, McDermott EW, O’Higgins N (2005) The accuracy of ultrasound, stereotactic, and clinical core biopsies in the diagnosis of breast cancer, with analysis of false-negative cases. Ann Surg 242:701–707

    Article  PubMed  Google Scholar 

  21. Harris GC, Denley HE, Pinder SE, Lee AH, Ellis IO, Elston CW, Evans A (2003) Correlation of histologic prognostic factors in core biopsies and therapeutic excisions of invasive breast carcinoma. Am J Surg Pathol 27(1):11–15

    Article  PubMed  Google Scholar 

  22. Qureshi NA, Beresford A, Sami S, Boparai R, Gosh S, Carmicael AR (2006) Imprint cytology of needle core-biopsy specimens of breast lesions: Is it a useful adjunt to rapid assessment breast clinics? Breast [Sept 2, Epub ahead of print]

  23. Poole K (1997) The emergence of the ‘waiting game’: a critical examination of the psychosocial issues in diagnosing breast cancer. J Adv Nurs 25:273–281

    Article  PubMed  CAS  Google Scholar 

  24. Woodward V, Webb C (2001) Women’s anxieties surrounding breast disorders: A systemic review of the literature. J Adv Nurs 33:29–41

    Article  PubMed  CAS  Google Scholar 

  25. Cornford CS, Harley J, Oswald N (2004) The ‘2-week rule’ for suspected breast carcinoma: a qualitative study of the views of patients and professionals. Br J Gen Pract 54:584–588

    PubMed  Google Scholar 

  26. O’Mahony M (2001) Women’s lived experience of breast biopsy: a phenomenological study. J Clin Nurs 10:512–520

    Article  PubMed  CAS  Google Scholar 

  27. Brett J, Bankhead C, Henderson B, Watson E, Austoker J (2005) The psychological impact of mammographic screening. A systematic review. Psychooncology 14:917–938

    Article  PubMed  CAS  Google Scholar 

  28. Brenner RJ, Fajardo L, Fisher PR et al (1996) Percutaneous core biopsy of the breast: Effect of operator experience and number of samples on diagnostic accuracy. Am J Roentgenol 166:341–346

    CAS  Google Scholar 

  29. Liberman L, Dershaw DD, Rosen PP et al (1994) Stereotactic 14-gauge breast biopsy – how many core biopsy specimens are needed. Radiology 192:793–795

    PubMed  CAS  Google Scholar 

  30. Fishman JE, Milikowski C, Ramsinghani R et al (2003) US-guided core-needle biopsy of the breast: how many specimens are necessary? Radiology 226:779–782

    Article  PubMed  Google Scholar 

  31. O’Leary R, Hawkins K, Beazley JC, Lansdown MR, Hanby AM (2004) Agreement between preoperative core needle biopsy and postoperative invasive breast cancer histopathology is not dependent on the amount of clinical material obtained. J Clin Pathol 57(2):193–195

    Article  PubMed  CAS  Google Scholar 

  32. Mueller-Holzner E, Fink V, Frede T, Marth C (2001) Immunohistochemical determination of HER2 expression in breast cancer from core biopsy specimens: a reliable predictor of HER2 status of the whole tumor. Breast Cancer Res Treat 69(1):13–19

    Article  PubMed  CAS  Google Scholar 

  33. Pijnappel RM, van den Donk M, Holland R, Mali WP, Peterse JL,Hendriks JH, Peeters PH (2004) Diagnostic accuracy for different strategies of image-guided breast intervention in cases of nonpalpable breast lesions. Br J Cancer 90(3):595–600

    Article  PubMed  CAS  Google Scholar 

  34. Jacobs TW, Connolly JL, Schnitt SJ (2002) Nonmalignant lesions in breast core needle biopsies. Am J Surg Pathol 26:1095–1110

    Article  PubMed  Google Scholar 

  35. Wells CA, The EC (2006) Working Group on Breast Cancer Screening Pathology: Quality assurance guidelines for pathology. European guidelines for quality assurance in breast cancer screening and diagnosis, 4th edn. European Commission, Luxembourg, p 255

    Google Scholar 

  36. Tavassoli FA (1992) Myoepithelial lesions of the breast. In: Tavassoli FA (ed) Pathology of the breast. Appleton & Lange, Norwalk, Connecticut, pp 593–609

    Google Scholar 

  37. Wells CA, The E.C Working Group on Breast Cancer Screening Pathology (2006) Quality assurance guidelines for pathology. European guidelines for quality assurance in breast cancer screening and diagnosis, 4th edn. European Commission, Luxembourg, p 224

    Google Scholar 

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Innsbruck Medical University, Anichstraße 35, 6020, Innsbruck, Austria

    Elisabeth Mueller-Holzner, Michael Ban, Susanne Taucher, Alois Schneitter, Alain G. Zeimet & Christian Marth

  2. Second Department of Radiology, Innsbruck Medical University, Anichstraße 35, 6020, Innsbruck, Austria

    Thomas Frede & Martin Daniaux

Authors
  1. Elisabeth Mueller-Holzner
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  2. Thomas Frede
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  3. Martin Daniaux
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  4. Michael Ban
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Correspondence to Elisabeth Mueller-Holzner.

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Mueller-Holzner, E., Frede, T., Daniaux, M. et al. Ultrasound-guided core needle biopsy of the breast: does frozen section give an accurate diagnosis?. Breast Cancer Res Treat 106, 399–406 (2007). https://doi.org/10.1007/s10549-007-9508-9

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  • DOI: https://doi.org/10.1007/s10549-007-9508-9

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