Skip to main content

Advertisement

SpringerLink
Log in

A comparison of the accuracy of two minimally invasive breast biopsy methods: a systematic literature review and meta-analysis

  • Original Article
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Objective: The primary objective was to quantify and compare the accuracy and failure rates of directional vacuum assisted biopsy (DVAB) and core needle biopsy (CNB) when used under stereotactic (ST) guidance to biopsy suspicious breast lesions identified with screening mammography. Methods: We performed a systematic review of the literature published from January 1996 to July 2004, reporting all-comers populations in Western-style health care systems (i.e., North America, Europe, Australia or New Zealand), referred after screening mammography for breast biopsy using DVAB or CNB under ST guidance. Meta-analyses were conducted for DVAB and CNB, using open surgical biopsy and/or long-term clinical and/or mammogram follow-up as the diagnostic reference standard. The main outcomes of interest were those of greatest clinical relevance, i.e., miss rates and underestimation rates for malignancy. Also, technical failure rate and non-diagnostic rate were assessed for each biopsy method. Results: Thirty-five studies qualified for the review. There were 12 studies with a DVAB group (n=5,119 patients), and 25 studies with a CNB group (n=6,236). There were no studies including both a DVAB and a CNB group, thus precluding any direct, within-study comparisons of accuracy. Overall agreement rate between DVAB and the reference standard was 97.3%, and between CNB and the reference standard, 93.5%. The frequency of technical failures with CNB was slightly higher than DVAB (5.7 vs. 1.5%), as was the frequency of non-diagnostic samples (2.1 vs. 0%). Of the non-diagnostic CNB samples, 23% were subsequently found to be malignant on reference standard. In multivariate analyses using four covariates (procedure type, geographic location, reference standard, and patient position), there were no significant predictors of agreement rates, but some variables were significant predictors of miss rates. For benign to malignant upgrades, study location was a significant predictor, with more upgrades in non-NA locations. For atypia to malignant upgrades, the type of procedure was a significant predictor, with more underestimations in CNB studies. Conclusion: The best available evidence suggests that, in screening populations referred for minimally invasive breast biopsy biopsy requiring ST guidance, DVAB may provide lower miss and underestimation rates for clinically relevant diagnoses than does CNB.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Alderson P, Green S, Higgins JPT (eds) (2004) Cochrane collaboration handbook 4.2.1 (updated December 2003). In: The Cochrane Library. Wiley, Chichester, Issue 1

  2. Banks E, Reeves G, Beral V, Bull D, Crossley B, Simmonds M, Hilton E, Bailey S, Barrett N, Briers P, English R, Jackson A, Kutt E, Lavelle J, Rockall L, Wallis MG, Wilson M, Patnick J. (2004) Impact of use of hormone replacement therapy on false positive recall in the NHS breast screening programme: results from the million women study. BMJ 328:1291–1292

    Article  PubMed  Google Scholar 

  3. Berg WA, Jaeger B, Campassi C, Kumar D (1998) Predictive value of specimen radiography for core needle biopsy of noncalaified breast masses. AJR Am J Roentgenol 171:1671–1678

    PubMed  CAS  Google Scholar 

  4. Brett J, Austoker J, Ong G (1998) Do women who undergo further investigation for breast screening suffer adverse psychological consequences? A multi-centre follow-up study comparing different breast screening result groups five months after their last screening appointment. J Public Health Med 20:396–403

    PubMed  CAS  Google Scholar 

  5. Burbank F, Parker SH, Fogarty TJ (1996) Stereotactive breast biopsy improved tissue harvesting with the Mammotome. Am Surg 62:738–744

    PubMed  CAS  Google Scholar 

  6. Burbank F (1997) Stereotactic breast biopsy of atypical ductal hyperplasia and ductal carcinoma in situ lesions: improved accuracy with directional vacuum-assisted biopsy. Radiology 202:843–847

    PubMed  CAS  Google Scholar 

  7. Burbank F, Parker SH (1998) Methods for evaluating the quality of an image-guided breast biopsy program. Semin Breast Dis 1:71–83

    Google Scholar 

  8. Cook DJ, Mulrow CD, Haynes RB (1997) Systematic reviews: synthesis of best evidence for clinical decisions. Ann Intern Med 126:376–380

    PubMed  CAS  Google Scholar 

  9. DerSimonian R, Laird N (1986). Meta-analysis in clinical trials. Control Clin Trials 7:177–188

    Article  PubMed  CAS  Google Scholar 

  10. Elmore JG, Barton MB, Moceri VM, Polk S, Arena PJ, Fletcher SW (1998) Ten-year risk of false positive screening mammograms and clinical breast examinations. N Engl J Med 338:1089–1096

    Article  PubMed  CAS  Google Scholar 

  11. Elmore JG, Carney PA, Abraham LA, Barlow WE, Egger JR, Fosse JS, Cutter GR, Hendrick RE, D’Orsi CJ, Paliwal P, Taplin SH (2004) The association between obesity and screening mammography accuracy. Arch Intern Med 164:1140–1147

    Article  PubMed  Google Scholar 

  12. Georgian-Smith D, D'Orsi C, Morris E, Clark CF, Liberty Jr E, Lehman CD (2002) Stereotactic biopsy of the breast using an upright unit, a vacuum-suction needle, and a lateral arm-support system. AJR Am J Roentgenol 178:1017–1024

    PubMed  Google Scholar 

  13. Hedges L, Olkin I (1985) Statistical methods for meta-analysis. Academic, Orlando, pp 230–257

  14. Humphrey LL, Chan BKS, Detlefsen S, Helfand M (2002) Screening for breast cancer. Systematic evidence review No. 15 (Prepared by the Oregon Health & Science University Evidence-based Practice Center under Contract No. 290-97-0018). Agency for Healthcare Research and Quality, Rockville. (Available on the AHRQ Web site at: www.ahrq.gov/clinic/serfiles.htm)

  15. Jackman RJ, Marzoni FA (1997) Needle-localized breast biopsy: why do we fail? Radiology 204:677–684

    PubMed  CAS  Google Scholar 

  16. Jackman RJ, Burbank F, Parker SH, Evans WP III, Lechner MC, Richardson TR, Smid AA, Borofsky HB, Lee CH, Goldstein HM, Schilling KJ, Wray AB, Brem RF, Helbich TH, Lehrer DE, Adler SJ (2001) Stereotactic breast biopsy of non-palpable lesions: determinants of ductal carcinoma in situ underestimation rates. Radiology 218:497–502

    PubMed  CAS  Google Scholar 

  17. Kettritz U, Rotter K, Schreer I, Murauer M, Schulz-Wendtland R, Peter D, Heywang-Kobrunner SH (2004) Stereotactic vacuum-assisted breast biopsy in 2874 patients: a multicenter study. Cancer 100:245–251

    Article  PubMed  Google Scholar 

  18. Lai JT, Burrowes P, MacGregor JH (2001) Diagnostic accuracy of a stereotaxically guided vacuum-assisted large-core breast biopsy program in Canada. Can Assoc Radiol J 52:223–227

    PubMed  CAS  Google Scholar 

  19. Lidbrink E, Elfving J, Frisell J, Jonsson E (1996) Neglected aspects of false positive findings of mammography in breast cancer screening: analysis of false positive cases from the Stockholm trial. BMJ 312:273–276

    PubMed  CAS  Google Scholar 

  20. Lowe JB, Balanda KP, Del Mar C, Hawes E (1999) Psychologic distress in women with abnormal findings in mass mammography screening. Cancer 85:1114–1118

    Article  PubMed  CAS  Google Scholar 

  21. Meloni GB, Becchere MP, Soro D, Feo CF, Profili S, Dettori G, Trignano M, Navarra G, Canalis GC (2002) Percutaneous vacuum-assisted core breast biopsy with upright stereotactic equipment. Indications, limitations and results. Acta Radiol 43:575–578

    Article  PubMed  CAS  Google Scholar 

  22. Parker SH, Burbank F (1996) A practical approach to minimally invasive breast biopsy. Radiology 200:1–20

    Google Scholar 

  23. Pijnappel RM, van den Donk M, Holland R, Mali WP, Peterse JL, Hendriks JL, et al (2004) Diagnostic accuracy for different strategies of image-guided breast intervention in cases of nonpalpable breast lesions. Br J Cancer 90:595–600

    Article  PubMed  CAS  Google Scholar 

  24. U.S. Preventive Services Task Force (1996) Guide to clinical preventive services, 2nd edn. Office of Disease Prevention and Health Promotion, Washington

    Google Scholar 

  25. Verkooijen HM (2002) Diagnostic accuracy of stereotactic large-core needle biopsy for nonpalpable breast disease: results of a multicenter prospective study with 95% surgical confirmation. Int J Cancer 99:853–859

    Article  PubMed  CAS  Google Scholar 

  26. Verkooijen HM, Peeters PH, Buskens E, Koot VC, Borel Rinkes IH, Mali WP, van Vroonhoven TJ (2000) Diagnostic accuracy of large-core needle biopsy for nonpalpable breast disease. Br J Can 82:1017–1021

    Article  CAS  Google Scholar 

  27. Verkooijen HM, Peeters PH, Pijnappel RM, Koot VC, Schipper ME, Borel Rinkes IH (2000) Diagnostic accuracy of needle-localized open breast biopsy for impalpable breast disease. Br J Surg 87:344–347

    Article  PubMed  CAS  Google Scholar 

  28. Wunderbaldinger P, Wolf G, Turetschek K, Helbich TH (2002) Comparison of sitting versus prone position for stereotactic large-core breast biopsy in surgically proven lesions. AJR Am J Roentgenol 178:1221–1225

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. MetaWorks, Inc., 10 President’s Landing, Boston, MA, 02155, USA

    Kyle Fahrbach, Isabella Sledge, Catherine Cella, Heather Linz & Susan D. Ross

Authors
  1. Kyle Fahrbach
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Isabella Sledge
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Catherine Cella
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Heather Linz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Susan D. Ross
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Susan D. Ross.

Accepted studies

Accepted studies

  1. 1.

    Ambrogetti D, Bianchi S, Ciatto S (2003) Accuracy of percutaneous core biopsy of isolated breast microcalcifications identified by mammography. Experience with a vacuum-assisted large-core biopsy device. Radiol Med (Torino) 106:313-319

  2. 2.

    Apesteguia L, Mellado M, Saenz J, Cordero JL, Reparaz B, De Miguel (2002) Vacuum-assisted breast biopsy on digital stereotaxic table of nonpalpable lesions non-recognisable by ultrasonography. Eur Radiol 12:638-645

  3. 3.

    Becker L, Taves D, McCurdy L, Muscedere G, Karlik S, Ward S (2001) Stereotactic core biopsy of breast microcalcifications: comparison of film versus digital mammography, both using an add-on unit. AJR Am J Roentgenol 177:1451-7

  4. 4.

    Blue J, Harman J (1998) Experience of the upright breast stereotactic core biopsy method and histological correlation with surgical biopsy. N Z Med J 111:191-2

  5. 5.

    Frayne J, Sterrett GF, Harvey J, Goodwin P, Townsend J, Ingram D, Parsons RW (1996) Stereotactic 14 gauge core-biopsy of the breast: results from 101 patients. ANZ Journal of Surgery 66:585-59

  6. 6.

    Fuhrman GM, Cederbom GJ, Bolton JS, King TA, Duncan JL, Champaign JL, Smetherman DH, Farr GH, Kuske RR, McKinnon WM (1998) Image-guided core-needle breast biopsy is an accurate technique to evaluate patients with nonpalpable imaging abnormalities. Ann Surg 227:932-939

  7. 7.

    Gray RE, Benson GW, Lustig DD (1999) Stereotactic breast biopsy: experience in a community setting. J Miss State Med Assoc 40:3-7

  8. 8.

    Head JF, Haynes AE, Elliott MC, Elliott RL (1996) Stereotaxic localization and core needle biopsy of nonpalpable breast lesions: two-year follow-up of a prospective study. Am Surg 62:1018-1023

  9. 9.

    Hirst C, Davis N (1997) Core biopsy for microcalcifications in the breast. ANZ J Surg 67:320-324

  10. 10.

    Howisey RL, Acheson MB, Rowbotham RK, Morgan A (1997) A comparison of Medicare reimbursement and results for various imaging-guided breast biopsy techniques. Am J Surg 173:395-8

  11. 11.

    Kirwan SE, Denton ER, Nash RM, Humphreys S, Michell MJ (2000) Multiple 14G stereotactic core biopsies in the diagnosis of mammographically detected stellate lesions of the breast. Clin Radiol 55:763-766

  12. 12.

    Lattanzio V, Guerrieri AM, Giardina C (2001) Interventional breast imaging: Mammotome. Tumori 87:S10-2

  13. 13.

    Levin MF, Papoff WJ, Doan L, Eliasziw M (2001) Stereotaxic percutaneous core biopsy versus surgical biopsy of nonpalpable breast lesions using a standard mammographic table with an add-on device. Can Assoc Radiol J 52:29-32

  14. 14.

    Makoske T, Preletz R, Riley L, Fogarty K, Swank M, Cochrane P, Blisard D (2000) Long-term outcomes of stereotactic breast biopsies. Am Surg 66:1104-1108

  15. 15.

    Nguyen M, McCombs MM, Ghandehari S, Kim A, Wang H, Barsky SH, Love S, Bassett LW (1996) An update on core needle biopsy for radiologically detected breast lesions. Cancer 78: 2340-2345

  16. 16.

    Pfarl G, Helbich TH, Riedl CC, Wagner T, Gnant M, Rudas M, Liberman L (2002) Stereotactic 11-gauge vacuum-assisted breast biopsy: a validation study. AJR Am J Roentgenol 179:1503-1507

  17. 17.

    Pitre B, Baron PL, Baron LF, O'Brien PH, Cole DJ (1997) Stereotactic core biopsy of the breast: results of one-year follow-up of 101 patients. Am Surg 63:1124-1127

  18. 18.

    Roth WD, von Smitten K, Heikkila P, Edgren J, Laasonen L (1999) Automated stereotactic core needle biopsy of microcalcifications with correlation to surgical biopsy. Acta Radiol 40:390-393

  19. 19.

    Seoudi H, Mortier J, Basile R, Curletti E (1998) Stereotactic core needle biopsy of nonpalpable breast lesions: initial experience with a promising technique Arch Surg 133:366-72

  20. 20.

    Soo MS, Ghate S, Delong D (1999) Stereotactic biopsy of noncalcified breast lesions: Utility of vacuum-assisted technique compared to multipass automated gun technique. Clin Imaging 23:347-352

  21. 21.

    Sutton S, Dahlstrom JE, Jain S (1997) Stereotactic large-gauge core biopsy: its role in the diagnosis of non-palpable mammographic abnormalities presenting to a screening service. Australas Radiol 41:103-8

  22. 22.

    Symmans WF, Weg N, Gross J, Cangiarella JF, Tata M, Mazzo JA, Waisman J (1999) A prospective comparison of stereotaxic fine-needle aspiration versus stereotaxic core needle biopsy for the diagnosis of mammographic abnormalities. Cancer 85:1119-1132

  23. 23.

    Taft R, Chao K, Dear P, King C (1996) The role of core biopsy in the diagnosis of mammographically detected lesions. ANZ J Surg 66:664-7

  24. 24.

    Vega Bolivar A, Ortega Garcia E, Garijo Ayensa F (1998) Stereotaxic core needle aspiration biopsy with multiple passes in nonpalpable breast lesions. Acta Radiol 39:389-94

  25. 25.

    Walker TM (1997) Impalpable breast lesions: Stereotactic core biopsy with an 'add-on" unit. Breast 6:126-131

  26. 26.

    Witmer DR, Dickson-Witmer D, Teixido R (1997) Initial 100 consecutive stereotactic core breast biopsies in a private breast center setting. Del Med J 69:297-301

  27. 27.

    Zannis VJ, Aliano KM (1998) The evolving practice pattern of the breast surgeon with disappearance of open biopsy for nonpalpable lesions. Am J S 176:525–528

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fahrbach, K., Sledge, I., Cella, C. et al. A comparison of the accuracy of two minimally invasive breast biopsy methods: a systematic literature review and meta-analysis. Arch Gynecol Obstet 274, 63–73 (2006). https://doi.org/10.1007/s00404-005-0106-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-005-0106-y

Keywords

Search

Navigation