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Re: Reliability of prognostic factors in breast needle core biopsies.

Dear Editor

The reliability of diagnostic and prognostic information in breast core biopsies is an important factor to be considered by surgeons and oncologists when planning treatment, especially if pre-operative chemotherapy is under consideration. The recent report by O’Leary et al.[1] is important because it considers whether the amount of tumour present in core biopsies has any impact upon the reliability of the information.

We completed a similar study of 134 women in whom core biopsies and a subsequent excision was available for comparison between 2001 and 2002 in Southampton. We showed similar results with a 69.1% overall agreement of invasive tumour grade and 61.1% overall agreement in DCIS grade between the core biopsy and excision with the grade tending to be underscored more often than overscored in the core biopsy. Agreement of 75.8% was seen for invasive tumour type. We also looked at the reliability of information dependent upon the amount of invasive carcinoma present using a measure of the linear length of tumour present in the cores. We analysed this by comparing three groups (<_2mm _2-10mm="_2-10mm" />10mm) and by a T-test (using continuous lengths of tumour) and both analyses showed no significant difference in the reliability of the prognostic information when the extent of invasive tumour is limited.

Although as O’Leary indicates, this is somewhat counterintuitive, it is a potentially important and reassuring observation for clinical decision making.

Reference

(1) R O’Leary, K Hawkins, J C S Beazley, M R J Lansdown, and A M Hanby. Agreement between preoperative core needle biopsy and postoperative invasive breast cancer histopathology is not dependent on the amount of clinical material obtained. J Clin Pathol 2004; 57: 193-195