Diagnostic value of fine-needle aspiration biopsy for breast mass: a systematic review and meta-analysis

Abstract

Background: Fine-needle aspiration biopsy (FNAB) of the breast is a minimally invasive yet maximally diagnostic method. However, the clinical use of FNAB has been questioned. The purpose of our study was to establish the overall value of FNAC in the diagnosis of breast lesions.

Methods: After a review and quality assessment of 46 studies, sensitivity, specificity and other measures of accuracy of FNAB for evaluating breast lesions were pooled using random-effects models. Summary receiver operating characteristic curves were used to summarize overall accuracy. The sensitivity and specificity for the studies data (included unsatisfactory samples) and underestimation rate of unsatisfactory samples were also calculated.

Results: The summary estimates for FNAB in diagnosis of breast carcinoma were as follows (unsatisfactory samples was temporarily exluded): sensitivity, 0.927 (95% confidence interval [CI], 0.921 to 0.933); specificity, 0.948 (95% CI, 0.943 to 0.952); positive likelihood ratio, 25.72 (95% CI, 17.35 to 28.13); negative likelihood ratio, 0.08 (95% CI, 0.06 to 0.11); diagnostic odds ratio, 429.73 (95% CI, 241.75 to 763.87); The pooled sensitivity and specificity for 11 studies, which reported unsatisfactory samples (unsatisfactory samples was considered to be positive in this classification) were 0.920 (95% CI, 0.906 to 0.933) and 0.768 (95% CI, 0.751 to 0.784) respectively. The pooled proportion of unsatisfactory samples that were subsequently upgraded to various grade cancers was 27.5% (95% CI, 0.221 to 0.296).

Conclusions: FNAB is an accurate biopsy for evaluating breast malignancy if rigorous criteria are used. With regard to unsatisfactory samples, futher invasive procedures are required in order to minimize the chance of a missed diagnosis of breast cancer.

Figure 1

Forest plot of estimates of sensitivity and specificity for FNAB (C1 was temporarily exluded) in the diagnosis of breast cancer. The point estimates of sensitivity and specificity from each study are shown as solid circles. Error bars are 95% confidence intervals. The authors' names indicate the studies.

Figure 2

SROC curves for FANB (C1 was temporarily exluded). Each study is represented by each solid circle in the meta-analysis. The size of the solid circle indicates the size of each study. SROC curves summarize the overall diagnostic accuracy.

Figure 3

Forest plot of estimates of sensitivity and specificity for FNAB in 11 studies which reported insufficient samples. Insufficient samples considered to be positive.

Figure 4

SROC curves for FANB of 11 studies which reported insufficient samples (insufficient samples was considered to be positive). Each study is represented by each solid circle in the meta-analysis. The size of the solid circle indicates the size of each study. SROC curves summarize the overall diagnostic accuracy.

Figure 5

Funnel graph for the assessment of potential publication bias in FNAB. The funnel graph plots the log of the DOR against the SE of the log of the DOR (an indicator of sample size). Forty-six circle represents forty-six studies in the meta-analysis. The line in the centre indicates the summary diagnostic odds ratio.