This paper is concerned with large-gauge needle biopsies of suspicious breast neoplasia
performed within a three-year period (22nd June 1999 through 21st December 2001).
Within that time 262 large-gauge needle biopsies as well as cytological punctions were
performed with the aim of diagnosing benign and malignant neoplasia. In the same
three-year period 29 malignant breast tumors were diagnosed. In one of the patients a
clinically and PHD verified alteration was found which pointed to Mb. Padget, while in
another patient an atypical ductal hyperplasia was confirmed by a pathohistological
test

Cvjetan Lež

Damir Buković

Dubravko Smuđ

Eduardo Giudici

Mladen Zadro

Nevia Buković

Rajko Fureš

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Coll. Antropol. 27 (2003) 1: 259–262UDC 618.19-006:616-076Original scientific paperLarge-Gauge Needle Biopsy inDiagnosing Malignant BreastNeoplasiaRajko Fure{1, Damir Bukovi}2, Cvjetan Le`3, Mladen Zadro1,Nevia Bukovi}4, Dubravko Smu|5 and Eduardo Giudici61 Department of Obstetrics and Gynecology, General Hospital »Zabok», Zabok, Croatia2 Department of Obstetrics and Gynecology, School of Medicine, University of Zagreb, Zagreb,Croatia3 Department of Pathology, General Hospital »Zabok», Zabok, Croatia4 Croatian Institute of Retirement Insurance, Zagreb, Croatia5 Department of Surgery, University Hospital Center »Zagreb», Zagreb, Croatia6 Department of Transfuziology, General Hospital »Pula», Pula, CroatiaA B S T R A C TThis paper is concerned with large-gauge needle biopsies of suspicious breast neopla-sia performed within a three-year period (22nd June 1999 through 21st December 2001).Within that time 262 large-gauge needle biopsies as well as cytological punctions wereperformed with the aim of diagnosing benign and malignant neoplasia. In the samethree-year period 29 malignant breast tumors were diagnosed. In one of the patients aclinically and PHD verified alteration was found which pointed to Mb. Padget, while inanother patient an atypical ductal hyperplasia was confirmed by a pathohistologicaltest.Key words: breast cancer, large-gauge needle biopsyIntroductionBreast cancer holds the first positionamong malignant neoplasia as a cause ofdeath in women. This statement is truefor the Republic of Croatia as well as formost countries in the world1,2. Over thelast thirty years or so there has been aconstant increase in the occurrence ofbreast cancer and in the death rate due tothis illness. Thus in 1970 there were 681newly established cases of breast cancerin women (rate 14.3 per 100,000) and inthe same year 327 women died of breast259Received for publication April 29, 2003cancer (rate 14.3 per 100,000). Ten yearslater, in 1980, there were 1,127 newly es-tablished cases of breast cancer (rate 47.5per 100,000), and in the same year 456women died from the same cause (19.1/100,000). Indications of a constant in-crease were recorded ten years later, so in1990 there were 1,461 newly diagnosedpatients with breast cancer (59.3/100,000),and in the same year 710 women died ofit (29.9/100,000). The latest evidence con-cerning the occurrence of breast canceraccording to the Cancer Register of theRepublic of Croatia shows that in 1995the number was that far the highest ever:1,779 cases (72.2/100,000) and that in thesame year 768 women died of that cause(31.2/ 100,000). The latest evidence bear-ing on the death rate due to breast cancerin women dates from 1998 when, accord-ing to the Cancer Register for the Repub-lic of Croatia, 794 women died of that ill-ness (32.2/100,000)1,2.Based on the afore-mentioned dataconcerning the increase of occurrence ofbreast cancer and the death rate of breastcancer patients it becomes obvious thatbetween 1970 and 1996 the incidence ofthe illness increased by 242% and thedeath rate by 218%1,2.Compared to other countries of theworld the Republic of Croatia shows amedium incidence of breast cancer, andwithin its boundaries the front position isheld by Istria, Primorsko-Goranska coun-ty and Zagreb. The highest incidence ofbreast cancer in the world has been re-corded in the developed countries of NorthAmerica and Europe, whereas the lowestincidence has been found in some Asianand African countries1,2.In 5% of newly diagnosed patients withbreast cancer in the Republic of Croatiathe tumor has spread regionally, whereasin 26% it shows distant metastases. Thisfact affects the possibilities, the resultsand the success of treatment as well asthe future prospects which are muchpoorer if patients with breast cancer havestarted treatment at an advanced stageof illness i.e. after the tumor has spread(which is the most common case)1–5.The risk of breast cancer occurrencegrows with age and is greater for womenwith personal and family history includ-ing breast cancer cases. The followingfactors are also indications of a higherrisk of breast cancer occurrence: earlymenarche, late menopause, prolonged ap-plication of oral contraceptives, prolong-ed use of estrogen in the postmenopausalperiod, nulliparity, first childbirth after30 years of age, higher educational level,higher socioeconomic status and atypicalbreast hyperplasia confirmed by biopsy.Among the factors suspected to affectbreast cancer but still lacking scientificconfirmation are the following: ethnicaldifferences influencing differences in diet(specifically fat intake), the influence ofpesticides, alcohol consumption, obesity,induced breech of pregnancy and physicalinactivity2,4–12. Large-gauge needle biopsyof malignant breast neoplasia has nowa-days proved to be a choice method, partic-ularly if it is ultrasound- guided and notrandom13–18.Materials and MethodsThis paper deals with large-gauge nee-dle biopsies of suspicious breast neopla-sia performed in the Division for BreastDiseases of the Department for Gynecol-ogy and Obstetrics of the General Hospi-tal »Zabok»in Zabok within a three-yearperiod (22nd June 1999 through 21st De-cember 2001). Within that time 262 large-gauge needle biopsies as well as cytologi-cal punctions were performed with theaim of diagnosing benign and malignantbreast neoplasia. Thirty large-gauge nee-dle biopsies of breast neoplasia found sus-picious in previous ultrasound and mam-mographic tests were carried out. Large-gauge needle biopsies were ultrasound260R. Fure{ et al.: Large-Gauge Needle Biopsy, Coll. Antropol. 27 (2003) 1: 259–262-guided which resulted in a high level ofaccuracy of the diagnostic test. A precon-dition for executing large-gauge needlebiopsies in case of suspicious neoplasmwas a previous mam- mographic test anda detailed ultrasound breast examinationenabling us to locate suspicious growthswith a high level of precision and to in-crease the accuracy of the subsequent bi-opsy. For the purpose of carrying out large-gauge needle biopsies of potentially ma-lignant breast neoplasia an automatic»pistol« BARD-MAGNUM with thick nee-dles (18–14 Gauge diameter which equals1.7–2.1 mm) was applied. We averagelyused 4 cylinders of tissue obtained bylarge-gauge needle biopsy, which was la-ter processed in the Department for Pa-thology of our hospital, and this proce-dure has resulted in a very accurate pa-thohistological diagnosis.Results and DiscussionIn the afore-mentioned three-year pe-riod 29 patients with a malignant breastneoplasia were diagnosed (by exact PHDverification of samples obtained throughlarge-gauge needle biopsy). In one patienta clinically confirmed alteration pointed toMb. Padget. The age evaluation of exa-minees falls within the 95% reliability in-terval, which in this case amounts to 46.8to 52.4 years of age. Their span extendsfrom 31 to a maximum of 82 years of agewith a standard deviation of 9.63 years.The number of childbirths ranges from 0to 9 with a standard deviation of 1.96.There were 47.22% of women with 2 child-births and 34.24% of women with onlyone childbirth. The pathohistological find-ings of 29 patients pointed to a ductal in-vasive breast cancer. In one patient Mb.Padget was confirmed and in another pa-tient an atypical ductal hyperplasia wasfound. It was proved that for the wholegroup of 30 patients with a suspicious ul-trasound or mammographic finding point-ing to malignant breast neoplasia, thepathohistological diagnosis correlated in96.66%, while only in one patient an aty-pical ductal hyperplasia was verified(3.33%). The average size of tumors was18 mm. In analyzing the interrelation-ship of pathohistological findings in sam-ples obtained by large-gauge needle bi-opsy and the diagnostic methods pointingto suspicious malignant breast neoplasiathere is low probability that these twomethods could be independent, because ofp<0.1 which points to the acceptability ofthe hypothesis about a high correlationbetween an accurate mammographic andultrasound diagnosis and its pathohisto-logical verification.ConclusionThe results that have been obtainedprove the acceptability of ultrasound-guided large-gauge needle biopsy in de-tecting malignant breast neoplasia. Wehave shown that by means of the above-described method very reliable resultshave been obtained as well as a rather ac-curate pathological verification of malig-nant breast neoplasia without causing se-rious trauma to the patients. The ad-vantage of teamwork between the gyne-cologist, the radiologist, the pathologist,the cytologist and the surgeon should beemphasized as particularly important be-cause it guarantees good results in treat-ing patients affected by malignant breastneoplasia. In our hospital such a team isin charge of the whole diagnostic andtherapeutic procedure including the sur-gery.261R. Fure{ et al.: Large-Gauge Needle Biopsy, Coll. Antropol. 27 (2003) 1: 259–262R E F E R E N C E S1. STRNAD, M., Podaci o u~estalosti i smrtnostiod raka dojke u Hrvatskoj od 1968.–1988. In: Regi-star za rak Republike Hrvatske. — 2. STRNAD, M.,M. HERCIGONJA-SZEKERES, Hrvatska treba svo-ju strategiju prevencije raka dojke. In: Proceedings.(1st Congress of the Senological Society, Zagreb, 2000).— 3. FURE[, R., D. BUKOVI], B. HODEK, P. KLA-RI], R. HERMAN, G. GRUBI[I], Coll. Antropol., 23(1999) 189. — 4. DRINKOVI], I., Intervencijski za-hvati pod ultrazvu~nom i mamografskom kontrolom.In: DRINKOVI], I. (Ed.): Radiolo{ko-ultrazvu~na di-jagnostika dojke. (Zina, 1997). — 5. DRINKOVI], I.,Ultrazvu~ni pregled zlo}udnih bolesti dojke. In:DRINKOVI], I. (Ed.): Radiolo{ko ultrazvu~na dijag-nostika dojke. (Zina, 1997). — 6. FORNAGE, B. D., J.Clin. Ultrasound, 27 (1999) 385. — 7. KOPJAR, M.,D. BUKOVI], M. ZADRO, R. FURE[, I. MARI^I],Coll. Antropol., 2 (1999) 629. — 8. M. KOPJAR, R.FURE[, M. ZADRO, C. LE@, F. SERDA, T. VISKO-VI], I. MARI^I], The possibilities of 3-D ultrasoundin diagnosis of breast cancer. In: Proceedings. (2nd Mi-lan Breast Cancer Conference, Milan, 2000). — 9.BUKOVI], D., N. LAKU[I], M. KOPJAR, I. MARI-^I] I., R. FURE[, D. MAHOVI], D. MARJAN, V.JURE[A, M. ZADRO, J. J. GRAH, M. [IMI], Coll.Antropol., 24 (2000) 53. — 10. FURE[, R., M. KOP-JAR, M. ZADRO, C. CLE[, F. SERDA, T. VISKOVI],I. MARI^I], 3-D ultrasound and breast cancer. In:Proceedings. (10th World Congress on Ultrasound inObstetrics and Gynecology, 2000). — 11. MEYER, J.E., D. N. SMITH, S. C. LESTER, C. KAELIN, P. J.DIPIRO, C. M. DENISON, R. L. CHRISTIAN, S. C.HARVEY, D. L. SELLAND, S. M. DURFEE, JAMA,281 (1999) 1638. — 12. DIAZ, L. K., E. L. WILEY, L.A. VENTA, Am. J. Roentgenol., 173 (1999) 1303. —13 STAREN, E. D., T. P. O’NEILL, Surgery, 126(1999) 629. — 14. JACOBS, T. W., J. F. SILVERMAN,B. SCHROEDER, S. RAZA, J. K. BAUM, S. J. SCH-NITT, Acta Cytol., 43 (1999) 169. — 15. CESARANI,F., G. ISOLATO, S. CAPELLO, S. D. BIANCHI, Ra-diol. Med., 97 (1999) 256. — 16. MARCHANT, D. J.,Int. J. Gynaecol. Obstet., 43 (1993) 3. — 17. FURE[,R., M. KOPJAR, F. SERDA, C. LE@, M. ZADRO, D.KOROLIJA, T. VISKOVI], M. AYOUB, I. MARI^I],D. MAMUZI], Suvremena dijagnostika i lije~enje ra-ka dojke. In: Proceedings. (3rd Croatian Congress ofGynecology and Obstetrics, Plitvice, 2001). — 18.FURE[, R., M. KOPJAR, F. SERDA, N. BE[ENSKIN., D. PAVI], I. DRINKOVI], M. ZADRO, C. LE@, T.VISKOVI], I. MARI^I], MR i 3D UZV u dijagnosticiraka dojke. U: Knji`ica sa`etaka. (Prvi Kongres Hr-vatskog onkolo{kog dru{tva, Zagreb, 2001).R. Fure{Department of Obstetrics and Gynecology, General Hospital »Zabok»,Trg Dragutina Domjani}a 6, 49210 Zabok, Croatia[IROKOIGLENA BIOPSIJA U DIJAGNOSTICI ZLO]UDNIHNOVOTVORINA DOJKES A @ E T A KU ovom radu izvr{ili smo prikaz u~injenih {irokoiglenih biopsija u suspektnih novo-tvorina dojke u trogodi{njem razdoblju (od 22.06.1999. do 31.12.2001. godine). U tomvremenu u~inili smo 262 {irokoiglene biopsija te citolo{kih punkcija u dijagnostici do-bro}udnih i zlo}udnih novotvorina dojki. U navedenom trogodi{njem razdoblju dijag-nosticirali smo u 29 bolesnika zlo}udnu novotvorinu dojki. U jedne bolesnice radilo se oklini~ki i PHD-om verificiranoj promjeni koja je govorila za Mb. Padget, dok se u jednebolesnice patohistolo{kim nalazom verificiralo atipi~nu duktalnu hiperplaziju.262R. Fure{ et al.: Large-Gauge Needle Biopsy, Coll. Antropol. 27 (2003) 1: 259–262

Large-Gauge Needle Biopsy in Diagnosing Malignant Breast Neoplasia

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