Performance Indices of Needle Biopsy Procedures for the Assessment of Screen Detected Abnormalities in Services Accredited by BreastScreen Australia

  • Published : 2015.01.22


Background: We wished to analyse patterns of use of needle biopsy procedures by BreastScreen Australia (BSA) accredited programs to identify areas for improvement. Design: 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.


  1. Ohsumi S, Taira N, Takabatake D, et al (2012). Breast biopsy for mammographically detected nonpalpable lesions using a vacuum-assisted biopsy device (Mammotome) and upright-type stereotactic mammography unit without a digital imaging system: experience of 500 biopsies. Breast Cancer.
  2. Rakha EA, Ho BC, Naik V, et al (2011). Outcome of breast lesions diagnosed as lesion of uncertain malignant potential (B3) or suspicious of malignancy (B4) on needle core biopsy, including detailed review of epithelial atypia. Histopathology, 58, 626-32.
  3. Roder DM, Ward GH, Farshid G, et al (2014). Influence of service characteristics on high priority performance indicators and standards in the BreastScreen Australia program. Asian Pac J Cancer Prev, 15, 5901-8.
  4. Sepandi M, Akrami M, Tabatabaee H, et al (2014). Breast cancer risk factors in women participating in a breast screening program: a study on 11,850 Iranian females. Asian Pac J Cancer Prev, 15, 8499-502.
  5. Sim MJ, Siva SP, Ramli IS, et al (2012). Effect of false-positive screening mammograms on rescreening in Western Australia. Med J Aust, 196, 693-5.
  6. Smith DN, Christian R, Meyer JE (1997). Large-core needle biopsy of nonpalpable breast cancers. The impact on subsequent surgical excisions. Arch Surg, 132, 256-9.
  7. Verkooijen HM, Borel Rinkes IH, Peeters PH, et al (2001). Impact of stereotactic large-core needle biopsy on diagnosis and surgical treatment of nonpalpable breast cancer. Eur J Surg Oncol, 27, 244-9.
  8. White RR, Halperin TJ, Olson JA, et al (2001). Impact of core-needle breast biopsy on the surgical management of mammographic abnormalities. Ann Surg, 233, 769-77.
  9. Whitten TM, Wallace TW, Bird RE, et al (1997). Image-guided core biopsy has advantages over needle localization biopsy for the diagnosis of nonpalpable breast cancer. Am Surg, 63, 1072-7.
  10. Liberman L (2002). Percutaneous image-guided core breast biopsy. Radiol Clin North Am, 40, 483-500.
  11. Liberman L, LaTrenta LR, Dershaw DD (1997). Impact of core biopsy on the surgical management of impalpable breast cancer: another look at margins. AJR Am J Roentgenol, 169, 1464-5.
  12. Bianchi S, Caini S, Renne G, et al (2011). Positive predictive value for malignancy on surgical excision of breast lesions of uncertain malignant potential (B3) diagnosed by stereotactic vacuum-assisted needle core biopsy (VANCB): a large multi-institutional study in Italy. Breast, 20, 264-70.
  13. Bruening W, Fontanarosa J, Tipton K, et al (2010). Systematic review: comparative effectiveness of core-needle and open surgical biopsy to diagnose breast lesions. Ann Intern Med, 152, 238-46.
  14. Dillon MF, McDermott EW, Hill AD, et al (2007). Predictive value of breast lesions of “uncertain malignant potential” and “suspicious for malignancy” determined by needle core biopsy. Ann Surg Oncol, 14, 704-11.
  15. El-Sayed ME, Rakha EA, Reed J, et al (2008). Predictive value of needle core biopsy diagnoses of lesions of uncertain malignant potential (B3) in abnormalities detected by mammographic screening. Histopathology, 53, 650-7.
  16. Farshid G, Rush G (2004). Assessment of 142 stellate lesions with imaging features suggestive of radial scar discovered during population-based screening for breast cancer. Am J Surg Pathol, 28, 1626-31.
  17. Humber and Yorkshire Coast Cancer Council. 2011. Guidelines for B3 vacuum assisted biopsy [Online]. Available: Final Guidelines for B3 Vacuum Assisted Biopsy April 2011 v1.3.pdf [Accessed November 2013 2013].
  18. Kaufman CS, Delbecq R, Jacobson L (1998). Excising the reexcision: stereotactic core-needle biopsy decreases need for reexcision of breast cancer. World J Surg, 22, 1023-7.

Cited by

  1. Contemporary indications for diagnostic open biopsy in women assessed for screen-detected breast lesions: A ten-year, single institution series of 814 consecutive cases vol.162, pp.1, 2017,