Application of the British National Health Service Breast Cancer Screening Programme classification in 226 breast core needle biopsies: correlation with resected specimens

• Published in: Annals of diagnostic pathology 2012-04, Vol.16 (2), p.112-118
• Main Authors: Pagni, Fabio, MD, Bosisio, Francesca Maria, MD, Salvioni, Daniele, MD, Colombo, Pietro, MD, Leone, Biagio Eugenio, MD, Di Bella, Camillo, MD
• Format: Article
• Language: English
• Subjects: Biopsy, Needle; Breast carcinoma; Breast Neoplasms - classification; Breast Neoplasms - pathology; Breast Neoplasms - surgery; CNB; Early Detection of Cancer; Female; FNAB; Humans; National Health Programs; Pathology; Retrospective Studies; Sensitivity and Specificity; State Medicine; United Kingdom
• ISSN: 1092-9134; 1532-8198
• DOI: 10.1016/j.anndiagpath.2011.08.003

Abstract A retrospective study correlating the diagnosis made on core needle breast biopsy (CNB) with the diagnosis made on the final surgical specimen was done using the British National Health Service Breast Cancer Screening Programme (NHSBSP) classification for CNB on 226 patients during a period of 15 months. Statistical analysis was used to evaluate sensitivity, specificity, and positive and negative predictive values of the NHSBSP diagnostic categories. Cohen κ was used to evaluate the agreement between the diagnosis on CNB and the final pathologic diagnosis in “clinically positive cases.” Finally, a comparative analysis between the CNB method and fine needle aspiration biopsy was made. The distribution of our cases for each diagnostic category reflects the literature guidelines, with minor differences in the B2 and B4 groups. Statistical data about the patients' follow-up revealed a small number of false-negative cases in the B1 and B2 categories and no false-positive cases in the B4 and B5 groups. Uncertain malignant lesions (B3 category) were divided into 3 major areas (papillary lesions, fibroepithelial proliferations with cellular stroma, and intraepithelial atypical lesions such as ductal intraepithelial neoplasia grade 1/lobular intraepithelial neoplasia grade 1). Of the 29 patients in the B3 category, 26 underwent surgery. Cohen κ analysis showed a strong statistical correlation ( κ = 0.77; Z = 4.3; significance >1.96; α = .05) between CNB diagnosis and surgical pathology final results in the subgroup of high-risk patients (diagnosis, ≥ductal intraepithelial neoplasia grade 1 on CNB). Global diagnostic power of CNB in all 226 cases revealed high sensitivity (88.3%) and slightly lower specificity (72.8%). In 42 “doubtful” cases, synchronous fine needle aspiration biopsy and CNB were performed, showing a complementary role in the diagnostic phase of breast lesions. Core needle breast biopsy represents the criterion standard method in the diagnostic phase of many breast tumors; the NHSBSP classification is a useful reporting system that provides a good standardization of the pathologic diagnosis and provides a clear guideline for the correct management of the patient.