Concordance of Core Needle Biopsy and Post-operative Histopathological Grading in Breast Carcinoma
DOI:
https://doi.org/10.64554/nujms.2026.2.1.1Keywords:
Breast carcinoma, Core biopsy, Histological grade, Surgical excision.Abstract
Background A core biopsy is commonly conducted as the first step in assessing the pathological grade of breast cancer. Discrepancies in histological grading can sometimes arise between core biopsy and surgical specimens. This holds significance in breast cancer cases because the histological grade plays a crucial role in identifying high-risk patients and
strongly influences the choice of treatment plan.
Objectives: To evaluate the concordance of histopathological grade between core needle biopsies and subsequent surgical excision specimens in patients with invasive breast carcinoma, and to determine factors that might affect the accuracy of grade classification.
Methods: a retrospective case-series agreement study was conducted at Al-Jamhuri Teaching Hospital, Mosul, Iraq. Eighty-eight consecutive breast core biopsies with invasive carcinoma were evaluated and compared with corresponding excision specimens. Comprehensive clinical, radiological, and pathological data were analyzed. Histological
grading and agreement were statistically analyzed. The study was approved by them institutional ethics committee.
Results: The histological grade concordance rate between core biopsy and corresponding excision specimen was 69.3% (61/88 cases). Discord occurred in 30.7% (27/88) of cases. Underestimation of the grade of the tumor was due primarily to misgrading the mitotic index in grade 1 and 2 tumors and to overestimation of the grade more in grade 3 tumors due to higher nuclear pleomorphism scores. Number of core biopsies taken (p = 0.041), total length of core biopsies (p = 0.001) and non-ultrasound-guided biopsy technique (p = 0.022) were all factors that significantly affected the accuracy of the grade.
Conclusion: Post-operative and core needle based histological grading in breast cancer agree poorly, but are clinically useful. The discrepancy might be related to underestimated mitotic index and intra-tumor heterogeneity. Clinicians should be cautious when deciding for treatment, especially neoadjuvant treatment, purely based on the grade obtained during core biopsy, due to this significant discrepancy. The results highlight the clinical significance of adopting a standardized approach in core biopsy techniques and cautioning for intra- and inter-observer grade variation in the multidisciplinary treatment plan. Further validation studies might be needed before using protocol changes in clinical practice.
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