[Preoperative needle biopsy: an improvement in palpable breast tumors with strong indications for malignancy]

To assess the value of needle core biopsy to replace frozen sections in palpable breast masses highly suspicious for malignancy.

Cohort study.

University Hospital Leiden, the Netherlands.

In 274 patients with 279 palpable breast masses a needle core biopsy was performed in addition to the triple diagnostic approach (i.e. physical examination, imaging by mammography and ultrasound and cytologic examination), if highly suspicious for malignancy. The core biopsy was performed by means of a 18-gauge needle in 89 lesions guided by palpation and in 190 lesions under ultrasound guidance. The results were compared with the final diagnosis: 19 benign lesions and 260 malignant lesions.

In 63 lesions the results of the triple diagnostic approach were unequivocally malignant, this was confirmed in all cases. In 208 lesions the results of the needle core biopsy were malignant, without false positive results. However, there were 3 false negative results. The proportion of inconclusive needle core biopsies was higher when performed on palpation (35%) than when performed under ultrasound guidance (7%). When the specimen showed non-invasive carcinoma, a reliable prediction of invasion was not possible. In 264 cases excision of the lesion was performed. Given the unequivocally malignant triple diagnostic approach in 59 cases of the 264 patients operated (22%) frozen sections were not performed. By addition of needle core biopsy this percentage rose to 74%.

Needle core biopsy is an important additional tool in the preoperative work-up of breast masses highly suspicious for malignancy, in order to reduce the number of frozen sections.