Diagnostic accuracy of needle-localized open breast biopsy for impalpable breast disease

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Abstract
Background: Needle-localized open breast biopsy (NLBB) is considered the gold standard procedure for the diagnosis of impalpable breast disease. In an observational follow-up study the sensitivity and negative predictive value of this procedure was determined in a clinical population with long-term follow-up. Methods: Some 199 consecutive patients with a benign histological diagnosis on NLBB were followed for the occurrence of breast cancer, using information from the Dutch National Morbid-Anatomical Record Department. Based on a review of mammograms and histological slides, an expert panel decided whether the carcinomas detected during follow-up were newly developed, or were present already at the time of the NLBB. Results: After a median follow-up of 60·5 months, seven carcinomas were detected. At panel review, six appeared to have been missed by NLBB. The sensitivity of NLBB was 99 per cent after 2 years of follow-up, but dropped to 96 per cent after 5 years. Similarly, the negative predictive value dropped from 99 per cent after 2 years to 94 per cent after 5 years of follow-up. Conclusion: NLBB is an accurate diagnostic procedure for the evaluation of impalpable breast disease. However, with longer follow-up the accuracy becomes lower than generally reported.