In the assessment of women who have a screening mammography showing suspicious findings, the aim is to minimise the need for surgical removal of non-clinically relevant lesions and, at the same time, to minimise the risk of missing a clinically relevant lesion.
The only way to significantly reduce both risks is to perform pre-surgical cytology or histopathology assessment of suspicious lesions.
Currently, there are two non-operative methods to obtain samples of a breast lesion: fine needle aspiration cytology involves the removal of cells which does not conserve the architectural structure of the lesion and needle core biopsy which removes tissue from the lesion. This recommendation evaluates these two different methods.
Should needle core biopsy vs. fine needle aspiration cytology be used to diagnose breast cancer in women with suspicious breast lesions in mammography?
In individuals with suspicious breast lesions (including mass lesions, asymmetric breast density, calcifications and/or architectural distortions) in mammography, the ECIBC's Guidelines Development Group (GDG) recommends needle core biopsy (NCB) over fine needle aspiration cytology (FNAC) to diagnose breast cancer.
Strong recommendation for the intervention
Moderate certainty of the evidence
Initially, the GDG had divided this question in 3 according to different types of subpopulations: 1. mass lesions and/or asymmetric density, 2. architectural distortions and 3. calcifications. As the literature search did not find studies giving information for the relevant outcomes separately, it was merged.
Considerations for implementation and policy making
The GDG noted that FNAC may have utility in other medical conditions or contexts (e.g. FNAC of axilla lymph nodes) and as such reinforces that this recommendation applies only to the population addressed in this question. The GDG did not consider other populations.
The GDG noted that there may be resistance to implementation in certain settings where providers are using FNAC over NCB. If monitoring the change to NCB should also imply to monitor other histopathology tests that are implemented in parallel to NCB.
Monitoring and evaluation
The GDG notes that the Quality Assurance Scheme Development Group (QASDG) should be alerted to this recommendation and consider monitoring and evaluation issues for this question.
Monitoring the positive predictive value of the intervention may be helpful for quality assurance. The GDG noted that centres currently performing FNAC instead of NCB (for the population in this question) should be monitored for the implementation of this intervention.
GDG encourages research on how to communicate more effectively with women so they can make an informed choice. This is particularly important in settings where FNAC is still used.