Korrelation bildgebender und histopathologischer Parameter von Mammaläsionen. Resultate der medizinischen Routineversorgung an der Universitätsfrauenklinik Marburg

The widespread use of preoperative image-guided large core needle biopsy in the early detection and diagnostic assessment of breast cancer has placed enormous demands upon the methods validation. Sufficient and correct characterisation of a suspicious breast lesion including differentiation between tumour-type, grade and hormone receptor status constitutes a crucial premise for early overall treatment management. The preceding triple diagnostic (including breast-sonography, mammography and clinical examination of the breast) produces combined diagnostic results, that potentially lead to subsequent biopsy and thus also needs validation. Guidelines (e.g. the “S3-Leitlinie zur Brustkrebsfrüherkennung in Deutschland”) are in place to ensure the overall quality of each diagnostic and therapeutic procedure in the assessment of breast lesions. The aim of this study was to evaluate the accuracy of core needle biopsy in the assessment of histological, prognostic and predictive factors referring to the final pathology report evaluation after surgical excision as the gold standard. Additionally sonography, mammography and clinical examination were validated according to their predictive potential when compared to subsequent histological results. Clinical implementation of the S3-guideline at the “Universitätsfrauenklinik Marburg” was also assessed. Core needle biopsy was performed in a consecutive series of 1388 patients with 1463 nonpalpable and palpable breast lesions between 2001 and 2004. Of these 1463 lesions 744 were surgically excised subsequent to core needle biopsy. Histological results on the surgical specimen were correlated with those on core biopsy samples for histologic type, grade, estrogen receptors (ER), progesterone receptors (PR), and Her2/neu levels. Mammography, sonography and clinical examination results were performed in advance and compared to histological results. Concordance between evaluation on surgical specimen and core biopsy samples was high for histologic type of tumour, tumour grade, ER, PR and HER2/neu-levels. Pre-invasive diagnostic procedures reliably predicted the histological outcome of breast lesions. The current guideline (“S3-Leitlinie zur Brustkrebsfrüherkennung in Deutschland) was effectively implemented into the daily management of breast lesions at the “Universitätsfrauenklinik Marburg”