J Clin Pathol 65:287-292 doi:10.1136/jclinpath-2011-200410
  • Review

Diagnosis of breast lesions: fine-needle aspiration cytology or core needle biopsy? A review

Editor's Choice
  1. P J van Diest1
  1. 1Department of Pathology, University Medical Center, Utrecht, The Netherlands
  2. 2Department of Pathology, Erasmus Medical Center, Rotterdam, The Netherlands
  1. Correspondence to Stefan M Willems, Department of Pathology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands; s.m.willems-4{at}
  1. Contributors SMW wrote the manuscript. CHMvD and PJvD contributed significantly to the content and the writing of the manuscript.

  • Accepted 27 September 2011
  • Published Online First 29 October 2011


Diagnosis of breast lesions is routinely performed by the triple assessment of a specialised surgeon, radiologist and pathologist. In this setting, fine-needle aspiration cytology (FNAC) and core needle biopsy (CNB) are the current methods of choice for pathological diagnosis, both with their specific advantages and limitations. Evidence-based literature discussing which of both modalities is preferable in breast lesion diagnosis is sparse and there is no consensus among different specialised breast cancer centres. This study reviews FNAC and CNB for diagnosing breast lesions, comparing methodological issues, diagnostic performance indices, possibilities for additional prognostic and predictive tests and cost effectiveness. Overall, CNB achieved better sensitivity and specificity especially in those lesions that were not definitively benign or malignant, non-palpable and/or calcified lesions. Although FNAC is easier to perform, interpretation requires vast experience and even then, it is more often inconclusive requiring additional CNB. The authors conclude that overall CNB is to be preferred as a diagnostic method.


  • Funding SMW is funded by the Netherlands Organization for Scientific Research (Rubicon grant 2011/07046/ALW) and the Dutch Cancer Society (clinical fellowship: 2011-4964).

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.