Trends in pre-operative needle biopsy use in invasive breast cancer diagnosis: a Dutch nationwide population study

Figures & data

Figure 1. Inclusion and exclusion of cases. ^aSamples contain all reports filed in March through April of the indicated year. ^bAutomatic analysis using keywords. ^cExcluded because report described a revision or external consultation. ^dManual validity check of the automatic process, performed on the first 200 reports per sample. ^eExcluded because reports did not contain a recent primary breast cancer (e.g., axillary surgery only, revision of older pathology specimen). ^fBilateral tumours in a single patient (parenthesis) were included as separate cases. ^gManual classification of all included reports. ^hTotal number of reports pertaining to the aforementioned number of cases.

Table 1. Results of automatic keyword recognition of pathology reports.

Year of report	Type of material	Number of reports	Accuracy compared to validity check
1996	CNB^a	312 (23%)	92%
	FNAC^b	1069 (77%)	94%
	Resection	2556	98%
	Unclassifiable	807
2001	CNB	903 (42%)	97%
	FNAC	1259 (58%)	100%
	Resection	3206	98%
	Unclassifiable	843
2006	CNB	2215 (66%)	100%
	FNAC	1143 (34%)	100%
	Resection	3133	98%
	Unclassifiable	757
2011	CNB	2556 (75%)	98%
	FNAC	858 (25%)	100%
	Resection	3536	97%
	Unclassifiable	1208
2016	CNB	3509 (83%)	99%
	FNAC	717 (17%)	100%
	Resection	3546	96%
	Unclassifiable	506

Distribution of pathology reports amongst categories: ‘CNB’, ‘FNAC’ ‘resection (either diagnostic, therapeutic, or both), ‘unclassifiable’ (by means of automatic keyword recognition). Validity check performed manually for the first 200 cases per sample.

^a CNB: core needle biopsy.

^b FNAC: fine needle aspiration cytology.

Figure 2. Shifts in the use of pre-operative needle biopsy.

Figure 3. Changes in availability of hormone receptor- and HER2 status.

Table 2. Results of detailed manual assessment.

Year/number of cases	1996/102	2001/100	2006/99	2011/103	2016/94
Type of needle biopsy
No needle biopsy^a	24 (23.5%)	25 (25%)	7 (7.1%)	3 (2.9%)	3 (3.2%)^f
FNAC^b	65 (63.7%)	36 (36%)	20 (20.2%)	14 (13.6%)	1 (1.1%)^f
CNB^c	10 (9.8%)	31 (31%)	56 (56.6%)	78 (75.6%)	70 (74.5%)^f
FNAC^b and CNB^c	3 (2.9%)	8 (8%)	16 (16.2%	8 (7.8%)	20 (21.3%)^f
Receptor status
ER^d status known pre-operatively	3 (2.9%)	16 (16%)	36 (36.4%)	62 (60.2%)	73 (77.7%)^f
ER^d status known post-operatively	48 (47.1%)	65 (65%)	91 (91.9%)	93 (90.3%)	91 (96.8%)^f
HER2^e status known pre-operatively	0	0	13 (13.1%)	35 (34.0%)	62 (66.0%)^f
HER2^e status known post-operatively	1 (1.0%)	8 (8%)	88 (88.9%)	92 (89.3%)	90 (95.7%)^f

Type of pre-operative needle biopsy and availability of oestrogen receptor and human epidermal growth factor receptor 2 of five times 100 cases of invasive breast cancer in the years 1996, 2001, 2006, 2011, and 2016.

^a No needle biopsy: diagnosis by means of surgical excision biopsy.

^b FNAC: fine needle aspiration cytology.

^c CNB: core needle biopsy.

^d ER: oestrogen receptor.

^e HER2: human epidermal growth factor receptor 2.

^f All separate trends over time are significant in a Cochran–Armitage test for trend, p < .001.