[Interventional methods in breast diagnosis. Histological vs. cytological evaluation of core cut biopsies of the breast].

Abstract

High speed core cut biopsies of breast tumors, sonographically or stereotactically guided, allow an histological examination of the tumor without surgery. It can be used prior to operation for the confirmation of a breast cancer and it can avoid unnecessary breast surgery in benign tumors. Unfortunately, only some centers are equipped with a pathology unit that allows an immediate histological examination. But often these institutes are provided with an experienced cystologist. Thus, the question arises if a cytology taken from the core cut biopsy is as reliable as an histological examination. In a prospective study we performed unroll-cytologies in core cut biopsies of 173 breast tumors in 169 patients consisting of 122 malignant and 51 benign tumors. Histology of core cut biopsies was proven by operational histology in all malignant and in 5 benign tumors. Histology of core cut biopsies could not be judged in 2 cases (lymphoma, gallert carcinoma). Cytological slide preparations were technically inadequate in 4 cases. The false negative rate of histology was 1/120 and 27/120 in cytology. Histology compared with cytology showed the following results: sensitivity 99.2% versus 77.5%, specificity 100% versus 95.9%, positive predictive value: 100% vs. 97.8%, negative predictive value: 98.1% vs. 63.5%, and accuracy: 99.4% vs. 82.8%. The sensitivity of cytology was much worse than that of histology of core cut biopsies. Thus, in our opinion cytology can provide a quick diagnostic orientation, but it cannot replace the more reliable histological examination. Diagnostic or therapeutic decisions should be based upon the more reliable histological results.