title: Performance indices of needle biopsy procedures for the assessment of screen detected abnormalities in services accredited by BreastScreen Australia.
abstract: BACKGROUND
  We wished to analyse patterns of use of needle biopsy procedures by BreastScreen Australia (BSA) accredited programs to identify areas for improvement.
  
  
  METHODS
  BSA services provided anonymous data regarding percutaneous needle biopsy of screen detected lesions assessed between 2005-2009.
  
  
  RESULTS
  12 services, from 5 of 7 Australian states and territories provided data for 18212 lesions biopsied. Preoperative diagnosis rates were 96.84% for lesion other than microcalcification (LOTM) and 93.21% for microcalcifications. At surgery 97.9% impalpable lesions were removed at the first procedure. Of 11548 Microcalcification (LOTM) biopsied, 46.9% were malignant. The final diagnosis was reached by conventional core biopsy (CCB) in 72.46%, FNAB in 21.33%, VACB in 1.69% and open biopsy in 4.52% of lesions. FNA is being limited to LOTM with benign imaging After FNAB, core biopsy was required for 38% of LOTM. In LOTM the mean false positive rate (FPR) was 0.36% for FNAB, 0.06% for NCB and 0% for VACB. Diagnostic accuracy was 72.75% for FNAB and 92.1% for core biopsies combined. Of 6441 microcalcifications biopsied 2305 (35.8%) were malignant. Microcalcifications are being assessed primarily by NCB but 6.57% underwent FNAB, 45.6% of which required NCB. False positive diagnoses were rare. FNR was 5% for NCB and 1.53% for VACB. Diagnostic accuracy was 73.52% for FNAB, 86.29% for NCB and 88.63% for VACB. Only 8 of 12 services had access to VACB facilities.
  
  
  CONCLUSIONS
  BSA services are selecting lesions effectively for biopsy and are achieving high preoperative diagnosis rates. Gaps in the present accreditation standards require further consideration.
authors.affiliation: Discipline of Medicine, University of Adelaide and SA Pathology, Wayville, South Australia E-mail : gelareh.farshid@health.sa.gov.au.
authors.forename: Gelareh
authors.initials: G
authors.lastname: Farshid
authors.forename: Thomas
authors.initials: T
authors.lastname: Sullivan
authors.forename: Simeon
authors.initials: S
authors.lastname: Jones
authors.forename: David
authors.initials: D
authors.lastname: Roder
mesh_terms: D000368:Aged; D001315:Australia; D001707:Biopsy, Needle; D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000175:diagnosis*; D002114:Calcinosis / Q000175:diagnosis*; D003695:Delivery of Health Care / Q000458:organization & administration / Q000592:standards*; D003937:Diagnosis, Differential; D005189:False Positive Reactions; D005260:Female; D005500:Follow-Up Studies; D006296:Health Services / Q000592:standards*; D006801:Humans; D008327:Mammography; D008403:Mass Screening / Q000592:standards*; D008875:Middle Aged; D060787:Neoplasm Grading; D011379:Prognosis; D015397:Program Evaluation