Abstract
Although breast needle core biopsy (NCB) is now a standard diagnostic procedure in
the triple assessment of screen-detected breast lesions, data on the false-positive
diagnoses of malignancy (malignant NCB ‘B5’ with normal/benign surgery) are lacking.
In this study, we have studied a large series of NCBs (101,440) to assess the causes
and pitfalls resulting in false-positive NCB diagnoses and to evaluate their impact
on patients’ management in the screening service. Our results showed that of 40,395
malignant NCBs reported during the period of this study, 174 NCBs are considered as
false-positives (0.43%; (95% confidence interval [CI] = 0.37–0.49%)). However, on review, 165 cases (95%) were found to be the result of true
removal of the whole lesion in the core with subsequent negative excision biopsy samples
(true-positive NCBs). This may reflect sampling of small screen detected lesions and
the use of larger core biopsies at assessment. The remaining 9 cases were considered
as true false-positive cores, giving a false-positive rate of 0.02% (95% CI = 0.01–0.04%). Analysis of these 9 cases showed that 8 cases, originally diagnosed as
DCIS, were classified as borderline lesions or lesions of uncertain malignant potential
after surgical excision. The classification and management of such borderline lesions
remains controversial and diagnostic surgical excision is usually the optimum management.
One case was the result of pathological misinterpretation of fat necrosis as invasive
carcinoma. This was the only case that resulted in a significant over-management of
the patient. In conclusion, our results showed that the true false-positive rate of
NCB is extremely rare. Significant over-management of screen-detected breast lesions
as a result of false-positive NCB may be considered almost nil.
Keywords
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Article info
Publication history
Published online: January 05, 2009
Accepted:
December 2,
2008
Received in revised form:
November 7,
2008
Received:
July 12,
2008
Identification
Copyright
© 2008 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
