Triple diagnostic approach versus ultrasound-guided 18 gauge core biopsy in suspicious breast masses

The aim was to assess the reliability and success rate of the triple diagnostic approach (i.e. physical examination, breast imaging and fine needle aspiration [FNA]) compared with ultrasound-guided 18 gauge core biopsy in determining the preoperative diagnosis of breast carcinoma. A cohort study was performed in 186 patients with 190 suspicious, palpable breast lesions. The final diagnosis was 8 benign and 182 malignant lesions (177 invasive and 5 non-invasive carcinomas). The results of the triple diagnostic approach were unequivocally malignant in only 57 of the 190 cases, i.e. a sensitivity of 31.3%. When including the probably malignant scores, the sensitivity increased to 73.1%. The sensitivity of the 18 gauge core biopsy was 88.5%; when excluding the non-invasive results it decreased to 84.6%. The study included too small a number of benign lesions to allow assessment of specificity. The yield of the triple diagnostic approach is low and is surpassed by core biopsy. However, even the results of core biopsy should be considered together with the results of physical examination and imaging. Core biopsy is a reliable substitute for FNA to obtain a definitive preoperative diagnosis.