CAN CORE NEEDLE-BIOPSY REPLACE FINE-NEEDLE ASPIRATION CYTOLOGY IN THEDIAGNOSIS OF PALPABLE BREAST-CARCINOMA - A COMPARATIVE-STUDY OF 124 WOMEN

BACKGROUND. There appears to be a growing movement in favor of core ne edle biopsy (CNB) over fine-needle aspiration (FNA) cytology in detect ing breast carcinoma in women. The authors compared the sensitivity an d specificity of these two methods in patients who presented to The Un iversity of Texas M. D. Anderson Cancer Center for evaluation of a pal pable breast mass. METHODS. One hundred and twenty-four women (mean ag e, 51 years; range, 28-86 years) with a clinically suspicious palpable mass (mean size, 4.4 cm; range, 1-12 cm) underwent concurrent FNA and CNB. For the FNA, an average of three needle passes were made. FNA wa s followed by three CNBs using the Bard Monopty needle. CNB samples we re submitted for frozen section to determine adequacy, and an addition al three cores were performed if the first batch was deemed inadequate . All patients ultimately had histologic confirmation of their neoplas ms either by the core needle procedure or by definitive open surgical biopsy. Features of cases with discrepant diagnoses were examined in r elation to tumor size and histologic type. RESULTS. Specificity of bot h FNA and CNB was 100%. The sensitivity in detecting a malignant neopl asm was higher for FNA than for CNB (97.5% vs. 90%, P < 0.004). CONCLU SIONS. In our experience, FNA of palpable breast lesions is a more sen sitive method for the detection of carcinoma regardless of tumor type, size, or differentiation. Contrary to other reports, not only was FNA alone more sensitive than CNB alone, the addition of CNB to an alread y negative FNA failed to increase sensitivity in the detection of carc inoma. However, CNB did contribute to a more definitive diagnosis in s ome cases. The authors also found FNA to be more cost effective than C NB for palpable breast lesions when time and effort are taken into con sideration. This reinforces the benefit of FNA over CNB in the detecti on of early stage breast carcinoma. (C) 1996 American Cancer Society.