What is the preferred method for breast biopsy: core needle biopsy (CNB) or fine needle aspiration (FNA)?

From the Guidelines

Core needle biopsy is the preferred method for breast biopsy due to its higher sensitivity and ability to provide tissue samples for definitive diagnosis, as recommended by the NCCN Guidelines 1. When it comes to breast biopsy, the choice between core needle biopsy and fine needle aspiration depends on various factors, including the clinical presentation, imaging findings, and availability of experienced pathologists.

• Core needle biopsy removes a small cylinder of tissue using a hollow needle (typically 14-16 gauge) and provides both histological architecture and cellular details, allowing for definitive diagnosis of both benign and malignant lesions and determination of important prognostic markers like hormone receptor status and HER2 status if cancer is found.
• Fine needle aspiration uses a thinner needle (21-25 gauge) to extract cells rather than intact tissue and while it's less invasive and may cause less discomfort, it provides only cytological information, which can be insufficient for complete diagnosis and characterization of breast lesions. The sensitivity for core needle biopsy directed by ultrasound or stereotaxis is 97% to 99%, making it a more reliable option for breast biopsy 1.
• Core needle biopsy is particularly important when evaluating suspicious calcifications, architectural distortions, or when tissue architecture is needed to distinguish between invasive and in situ carcinoma.
• Fine needle aspiration may still be useful for simple cyst evaluation or in settings with limited resources. According to the ACR Appropriateness Criteria, core biopsy is superior to fine-needle aspiration biopsy in terms of sensitivity, specificity, and correct histological grading of palpable masses 1.
• The decision to perform surgical excisional versus percutaneous biopsy should involve the patient and her health care provider, but image-guided core-needle biopsy has become the procedure of choice for most image-detected breast lesions requiring tissue diagnosis.

From the Research

Comparison of Core Needle Biopsy and Fine Needle Aspiration for Breast Biopsy

• Core needle biopsy (CNB) and fine needle aspiration (FNA) are two methods used for breast biopsy, each with its own advantages and disadvantages 2, 3, 4, 5, 6.
• Studies have shown that CNB has a higher diagnostic accuracy than FNA, especially in certain types of breast cancer, such as invasive lobular carcinoma and apocrine carcinoma 2.
• FNA has been found to have a lower sensitivity than CNB in detecting malignancy in some types of breast cancer, but the combination of FNA and CNB can improve the diagnostic accuracy 2, 6.
• CNB is also useful in providing additional prognostic and predictive markers, which can aid in the management of breast cancer patients 5.
• The choice between CNB and FNA may depend on the specific clinical situation and the availability of resources, but CNB is generally considered to be a more reliable method for breast biopsy 3, 4, 5, 6.

Diagnostic Accuracy of Core Needle Biopsy and Fine Needle Aspiration

• The diagnostic accuracy of CNB and FNA can vary depending on the type of breast cancer and the expertise of the practitioner 2, 3, 4, 5, 6.
• CNB has been shown to have a higher sensitivity than FNA in detecting malignancy in some types of breast cancer, but FNA can still be useful in certain situations, such as when CNB is not feasible or when a rapid diagnosis is needed 2, 6.
• The combination of FNA and CNB can improve the diagnostic accuracy and provide a more comprehensive evaluation of the breast lesion 6.

Clinical Implications of Core Needle Biopsy and Fine Needle Aspiration

• The choice between CNB and FNA can have significant implications for the management of breast cancer patients, including the need for additional testing, surgery, or other treatments 3, 4, 5, 6.
• CNB is generally considered to be a more reliable method for breast biopsy, but FNA can still be useful in certain situations, such as when CNB is not feasible or when a rapid diagnosis is needed 2, 6.
• The use of CNB and FNA should be guided by clinical judgment and the availability of resources, with the goal of providing the most accurate and comprehensive evaluation of the breast lesion 3, 4, 5, 6.