Screen-detected ductal carcinoma in situ - fine needle aspiration versus core biopsy

Our current practice in the investigation of micro-calcification is to perform fine needle aspiration (FNA), with immediate results, and vacuum-assisted core biopsy (VACB), which was introduced in April 2007. The British Association Of Surgical Oncology 2006/2007 audit reported fewer centres using cytology alone for diagnosis of screen-detected cancer. We assessed the contribution of FNA to non-operative diagnosis of microcalcification, and the benefit to women in having immediate FNA results. We also investigated the effect of introducing VACB, rather than core biopsy for sampling microcalcification, on the number of repeat cores, and on the non-operative diagnosis of microcalcification.

We reviewed the accuracy of FNA versus core biopsy of 150 patients with microcalcification between April 2008 and March 2009 by reference to imaging and histology findings and comparison with results from the previous 2 years.

In 2008/2009, 49% cases were malignant microcalcification. The non-operative diagnostic FNA and core biopsy results for 2008/2009 were 42% and 90%, respectively. The corresponding values for 2007/2008 were 28% and 88%, respectively, and for 2006/2007 39% and 63%, respectively. Introduction of VACB has resulted in higher non-operative diagnostic malignant cores - 90% in 2008/2009 and 88% in 2007/2008 versus 63% in 2006/2007 - and fewer repeat cores - 11% in 2008/2009 and 16% in 2007/2008 versus 33% in 2006/2007.

The continued use of FNA in the investigation of micro-calcification will be reviewed in terms of its role in giving a same-day diagnosis in clinics, particularly when VACB is used for first-line diagnosis.