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Cancer Screening, Diagnosis and Care

European guidelines on breast cancer screening and diagnosis


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9. Further assessment after the mammogram

Obtaining a sample from a suspicious breast lesion

Issued on: February 2017

Healthcare question

Should needle core biopsy vs. fine needle aspiration cytology be used to diagnose breast cancer in women with suspicious breast lesions in mammography?

Recommendation

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.

Recommendation strength

Strong recommendation
Moderate certainty of the evidence

Subgroup considerations

Initially, the GDG had divided this question in three 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.

Research priorities

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.

Supporting material

yes