Spectrum of lesions encountered and accuracy of core needle biopsy of breast

A wide spectrum of non-neoplastic and neoplastic lesions can affect the breast. Core needle biopsy (CNB) forms an integral part of the Triple test to evaluate breast lumps and is progressively replacing fine needle aspiration cytology(FNAC). The present study was planned to evaluate the accuracy of diagnosis and spectrum of lesions encountered on CNB.

A retrospective analysis of CNB received over a two year period was done. CNBs were categorized using the UK National Health services breast screening programme (NHSBSP) guidelines and correlated with subsequent excision wherever available.

68 CNB were received, 65/68 had a palpable lump. Malignant lesions(B5) were the most common (43%) followed by B1. Infiltrating duct Carcinoma (IDC-NST) was the most common malignancy. Proliferative and Non proliferative benign lesions, granulomatous and non-specific inflammation, Fibroadenoma and Phyllodes tumor were some of the other lesions seen. Overall concordance between CNB and final excision was 71.4%. 8/10 discordant CNB were from Category B1. For detection of malignancy overall sensitivity, specificity, positive predictive value(PPV), negative predictive value (NPV) and accuracy were 90.4%, 100%, 100%, 87.5% and 94.2% respectively. Sensitivity, specificity, PPV, NPV and accuracy in biopsies with more than 3 cores was 100%.

A wide spectrum of lesions can be diagnosed on CNB and CNB is accurate, sensitive and specific for preoperative diagnosis. Study of more than three cores per biopsy and a multidisciplinary approach with clinicoradiologic correlation will improve overall sensitivity and NPV.