title: Diagnostic accuracy of large-core needle biopsy for nonpalpable breast disease: a meta-analysis.
abstract: For the evaluation of non-palpable lesions of the breast, image-guided large-core needle biopsies are increasingly replacing needle-localized open breast biopsies. In this study, the diagnostic accuracy of this minimally invasive technique was evaluated by reviewing the available literature. Five cohort studies were included in a meta-analysis. Sensitivity rate, histological agreement between needle biopsy and subsequent surgery or long-term mammographic follow-up and clinical consequences for different disease prevalences were assessed. The sensitivity rate of large-core needle biopsy for the diagnosis of breast cancer was high (97%). The reclassified agreement rate between core biopsy and subsequent surgical biopsy or long-term mammographic follow-up was also high (94%). In case of 20% breast cancer prevalence among women referred after screening (as in the US), the risk of breast cancer despite benign large-core needle biopsy result is less than 1%. In European countries, however, prevalence of breast cancer among referred women is 60-70%. This would result in a risk of breast cancer despite benign large-core needle biopsy result of 4-6%. The results of this meta-analysis indicate that the image guided large-core needle biopsy is a promising alternative for the needle localized breast biopsy. However, additional research is needed to explore the limiting factors of the technique. Without such detailed knowledge, a benign histological diagnosis on large-core needle biopsy in countries with high prevalence of malignancy among referred women should be interpreted with caution.
authors.affiliation: Department of Surgery, University Hospital Utrecht, The Netherlands.
authors.forename: H M
authors.initials: HM
authors.lastname: Verkooijen
authors.forename: P H
authors.initials: PH
authors.lastname: Peeters
authors.forename: E
authors.initials: E
authors.lastname: Buskens
authors.forename: V C
authors.initials: VC
authors.lastname: Koot
authors.forename: I H
authors.initials: IH
authors.lastname: Borel Rinkes
authors.forename: W P
authors.initials: WP
authors.lastname: Mali
authors.forename: T J
authors.initials: TJ
authors.lastname: van Vroonhoven
mesh_terms: D001707:Biopsy, Needle / Q000379:methods; D001941:Breast Diseases / Q000175:diagnosis / Q000473:pathology*; D005260:Female; D006801:Humans; D011237:Predictive Value of Tests; D011786:Quality Control; D016032:Randomized Controlled Trials as Topic; D012680:Sensitivity and Specificity