Excisional biopsy versus core-needle biopsy in breast cancer patients undergoing breast-conserving surgery: a comparative study

doi:10.3877/cma.j.issn.1674-0807.2026.02.003

Abstract

Abstract:

Objective

To compare the clinical efficacy and safety of excisional biopsy (EB) and core-needle biopsy (CNB) in breast cancer patients undergoing breast-conserving surgery (BCT) .

Methods

A retrospective study was conducted on the clinical data of 243 breast cancer patients who underwent BCT in the Chengdu Women and Children's Central Hospital between July 2017 and October 2024. According to the preoperative biopsy method, the patients were divided into the EB group (n=70) and the CNB group (n=173) . A dual-tracer method using methylene blue combined with indocyanine green was used for sentinel lymph node (SLN) mapping. The number of intraoperative SLNs detected, positive margin rate, postoperative complication rate, and patient satisfaction with breast appearance were compared between the two groups. Normally distributed continuous variables were compared using the independent sample t test, and continuous variables with a skewed distribution were analyzed using the Mann–Whitney U test. Categorical variables were compared using χ² test or Fisher's exact test. Ordinal variables were compared using nonparametric tests.

Results

The number of SLNs detected intraoperatively was 4.0 (0.0, 9.0) in the EB group and 4.0 (1.0, 13.0) in the CNB group (Z=-0.267, P=0.790) . The positive margin rate was 22.9% (16/70) and 32.4% (56/173) , respectively, indicating no significant difference ( χ²=2.163, P=0.141) . Patients were followed up for 1.0 to 89.3 months. The follow-up time was 32.2 (13.3, 53.1) months in the EB group and 32.8 (17.6, 52.6) months in the CNB group, indicating no significant difference (Z=-0.491，P=0.624). There was no significant difference in the postoperative complication rate between the EB group and the CNB group [5.7% (4/70) vs 5.8% (10/173) , χ²=0.000, P=1.000]. One patient in the EB group developed local recurrence, and two patients in the CNB group developed distant metastasis. For patients in the EB group and CNB group, the breast appearance was assessed as excellent, good, fair, and poor in 45, 24, 0, 1 cases and 91, 80, 1, 1 cases， respectively, suggesting no significant difference between the two groups (Z=-1.612, P=0.107) .

Conclusion

In breast cancer patients undergoing BCT, preoperative EB and CNB demonstrate comparable clinical efficacy and safety.

Key words: Breast neoplasms, Breast-conserving surgery, Excisional biopsy, Core-needle biopsy

Xiao Xiao, Xinlan Zhang, Yimei Tang, Yuting Wu, Yun Zhou, Xiaorong Han. Excisional biopsy versus core-needle biopsy in breast cancer patients undergoing breast-conserving surgery: a comparative study[J]. Chinese Journal of Breast Disease(Electronic Edition), 2026, 20(02): 91-97.

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Figures/Tables 2

临床病理特征	EB组（n=70）	CNB组（n=173）	统计量值	P值
年龄
<45岁	30	65	χ²=0.585	0.445
≥45岁	40	108	χ²=0.585	0.445
BMI
<24 kg/m²	44	108	χ²=0.004	0.950
≥24 kg/m²	26	65	χ²=0.004	0.950
高血压
是	7	17	χ²=0.002	0.967
否	63	156	χ²=0.002	0.967
糖尿病
是	4	5	χ²=0.463	0.496
否	66	168	χ²=0.463	0.496
吸烟
是	0	2	—	1.000^e
否	70	171	—	1.000^e
术前临床分期^a
0	13	10	Z=-5.799	<0.001
Ⅰ	48	72
Ⅱ	8	89
Ⅲ	1	2
肿瘤位置
外上象限	29	62	χ²=3.848	0.427
外下象限	11	24
内上象限	7	34
内下象限	4	13
其他^b	19	40
腋窝淋巴结转移
是	9	35	χ²=1.828	0.176
否	61	138	χ²=1.828	0.176
术后病理分期^a
NRC 及 0	13	14	Z=-3.185	0.001
Ⅰ	45	97
Ⅱ	9	55
Ⅲ	3	7
分子分型^c
Luminal A	18	46	χ²=9.483	0.023
Luminal B	29	77
HER-2阳性	6	22
HER-2阴性	23	55
HER-2 过表达	0	23
TNBC	10	19
新辅助治疗			χ²=9.788	0.002
是	0	22
否	70	151
辅助化疗
是	28	109	χ²=10.725	0.001
否	42	64	χ²=10.725	0.001
辅助靶向治疗^d
是	5	44	χ²=10.220	0.001
否	64	128	χ²=10.220	0.001
辅助内分泌治疗
是	52	124	χ²=0.170	0.680
否	18	49	χ²=0.170	0.680

变量	EB组（n=70）	CNB组（n=173）	统计量值	P值
手术时间［min，M（P₂₅，P₇₅）］	170.0 （135.0，225.0）	175.0 （150.0，207.5）	Z=-0.377	0.706
切缘阳性（例）			χ²=2.163	0.141
是	16	56
否	54	117
腋窝手术^a（例）			—	<0.001^c
未做	10	1
SLNB	54	137
ALND	5	30
SLNB后ALND	2	5
SLNB数［枚，M（P₂₅，P₇₅）］	4.0（3.0，5.0）	4.0（3.0，5.0）	Z=-0，267	0.790
ALND数^b（枚， $x ¯$ ±s）	18.8±6.4	17.9±7.2	t=0.359	0.721
住院时间［d，M（P₂₅，P₇₅）］	11.0 （8.0，14.0）	14.0 （11.0，16.0）	Z=-4.060	<0.001

变量	EB组（n=70）	CNB组（n=173）	统计量值	P值
手术时间［min，M（P₂₅，P₇₅）］	170.0 （135.0，225.0）	175.0 （150.0，207.5）	Z=-0.377	0.706
切缘阳性（例）			χ²=2.163	0.141
是	16	56
否	54	117
腋窝手术^a（例）			—	<0.001^c
未做	10	1
SLNB	54	137
ALND	5	30
SLNB后ALND	2	5
SLNB数［枚，M（P₂₅，P₇₅）］	4.0（3.0，5.0）	4.0（3.0，5.0）	Z=-0，267	0.790
ALND数^b（枚， $x ¯$ ±s）	18.8±6.4	17.9±7.2	t=0.359	0.721
住院时间［d，M（P₂₅，P₇₅）］	11.0 （8.0，14.0）	14.0 （11.0，16.0）	Z=-4.060	<0.001

References 31

［1］	Kong YC，Bhoo-Pathy N，O'Rorke M，et al. The association between methods of biopsy and survival following breast cancer：a hospital registry based cohort study［J］. Medicine（Baltimore）， 2020， 99（6）： e19093.
［2］	莫永泮，韩晓蓉，吴坤河，等. 空芯针穿刺活组织检查与开放性手术活组织检查对乳腺癌手术质量及预后的影响［J/OL］. 中华乳腺病杂志（电子版），2015，9（1）： 39-43.
［3］	张国锋，屈欣荣，李艳，等. 基于空芯针穿刺活组织检查的乳腺纤维上皮性肿瘤患者治疗策略［J/OL］. 中华乳腺病杂志（电子版）， 2024， 18（5）： 264-268.
［4］	Kuo YL，Chang TW. Can concurrent core biopsy and fine needle aspiration biopsy improve the false negative rate of sonographically detectable breast lesions？［J］. BMC Cancer， 2010， 10（1）： 371.
［5］	Lorgis V，Algros MP，Villanueva C，et al. Discordance in early breast cancer for tumour grade，estrogen receptor，progesteron receptors and human epidermal receptor-2 status between core needle biopsy and surgical excisional primary tumour［J］. Breast， 2011， 20（3）： 284-287.
［6］	Arnedos M，Nerurkar A，Osin P，et al. Discordance between core needle biopsy（CNB）and excisional biopsy（EB）for estrogen receptor（ER），progesterone receptor（PgR）and HER2 status in early breast cancer（EBC）［J］. Ann Oncol， 2009， 20（12）： 1948-1952.
［7］	Schueller G，Schueller-Weidekamm C，Helbich TH. Accuracy of ultrasound-guided，large-core needle breast biopsy［J］. Eur Radiol， 2008， 18（9）： 1761-1773.
［8］	Loughran CF，Keeling CR. Seeding of tumour cells following breast biopsy：a literature review［J］. Br J Radiol，2011，84（1006）：869-874.
［9］	Tham TM，Iyengar KR，Taib NA，et al. Fine needle aspiration biopsy，core needle biopsy or excision biopsy to diagnose breast cancer-which is the ideal method？［J］. Asian Pac J Cancer Prev， 2009，10（1）：155-158.
［10］	Teng R，Wei Q，Zhou J，et al. The influence of preoperative biopsy on the surgical method in breast cancer patients：a single-center experience of 3，966 cases in China［J］. Gland Surg， 2021， 10（3）： 1038-1045.
［11］	Czerniecki BJ，Scheff AM，Callans LS，et al. Immunohistochemistry with pancytokeratins improves the sensitivity of sentinel lymph node biopsy in patients with breast carcinoma［J］. Cancer， 1999， 85（5）： 1098-1103.
［12］	郭向阳，曲隽渊，薛登峰，等. 乳腺癌术前肿物切除活检对亚甲蓝腋窝前哨淋巴结染色成功率的影响［J］. 中国药物与临床，2021， 21（6）： 914-916.
［13］	Fentiman IS，Millis RR，Chaudary MA，et al. Effect of the method of biopsy on the prognosis of and reliability of receptor assays in patients with operable breast cancer［J］. Br J Surg， 1986， 73（8）： 610-612.
［14］	King TA，Hayes DH，Cederbom GJ，et al. Biopsy technique has no impact on local recurrence after breast-conserving therapy［J］. Breast J， 2001， 7（1）： 19-24.
［15］	章佳波，叶丹，朱红，等. 吲哚菁绿联合亚甲蓝染色在不同活检方式确诊的乳腺癌前哨淋巴结活检中的应用［J］. 现代实用医学，2020， 32（6）： 658-659， 742.
［16］	李昕宇，李玉东，刘强. 乳腺癌前哨淋巴结活组织检查的临床应用［J/OL］. 中华乳腺病杂志（电子版），2025，19（2）： 108-112.
［17］	苑龙，周艳，胡滢，等. 吲哚菁绿联合亚甲蓝在乳腺癌前哨淋巴结活组织检查中的应用价值［J/OL］. 中华乳腺病杂志（电子版）， 2016， 10（2）： 87-91.
［18］	张永松，梁全琨，钟玲，等. 纳米炭和亚甲蓝联合核素示踪法在腔镜乳腺癌前哨淋巴结活组织检查中的对照研究［J/OL］. 中华乳腺病杂志（电子版）， 2015， 9（4）： 231-235.
［19］	Harris DL. Self-consciousness of disproportionate breast size：a primary psychological reaction to abnormal appearance［J］. Br J Plast Surg， 1983， 36（2）： 191-195.
［20］	中国抗癌协会乳腺癌专业委员会，中华医学会肿瘤学分会乳腺肿瘤学组. 中国抗癌协会乳腺癌诊治指南与规范（2024年版）［J］. 中国癌症杂志，2023，33（12）：1092-1186.
［21］	van Bommel AC，Spronk PE，Vrancken Peeters MT，et al. Clinical auditing as an instrument for quality improvement in breast cancer care in the Netherlands：the national NABON Breast Cancer Audit［J］. J Surg Oncol， 2017， 115（3）： 243-249.
［22］	Bruening W，Fontanarosa J，Tipton K，et al. Systematic review：comparative effectiveness of core-needle and open surgical biopsy to diagnose breast lesions［J］. Ann Intern Med， 2010， 152（4）： 238-246.
［23］	Cahill RA，Walsh D，Landers RJ，et al. Preoperative profiling of symptomatic breast cancer by diagnostic core biopsy［J］. Ann Surg Oncol， 2006， 13（1）： 45-51.
［24］	Chen J，Wang Z，Lv Q，et al. Comparison of core needle biopsy and excision specimens for the accurate evaluation of breast cancer molecular markers： a report of 1003 cases［J］. Pathol Oncol Res， 2017， 23（4）： 769-775.
［25］	Ough M，Velasco J，Hieken TJ. A comparative analysis of core needle biopsy and final excision for breast cancer：histology and marker expression［J］. Am J Surg， 2011， 201（5）： 692-694.
［26］	Chen R，Qi Y，Huang Y，et al. Diagnostic value of core needle biopsy for determining HER2 status in breast cancer，especially in the HER2-low population［J］. Breast Cancer Res Treat， 2023， 197（1）： 189-200.
［27］	Nakano S，Imawari Y，Mibu A，et al. Differentiating vacuum-assisted breast biopsy from core needle biopsy：is it necessary？［J］. Br J Radiol， 2018， 91（1092）： 20180250.
［28］	Wang ZL，Liu G，Li JL，et al. Breast lesions with imaging-histologic discordance during 16-gauge core needle biopsy system：would vacuum-assisted removal get significantly more definitive histologic diagnosis than vacuum-assisted biopsy？［J］. Breast J， 2011， 17（5）： 456-461.
［29］	Povoski SP，Jimenez RE，Wang WP. Ultrasound-guided diagnostic breast biopsy methodology：retrospective comparison of the 8-gauge vacuum-assisted biopsy approach versus the spring-loaded 14-gauge core biopsy approach［J］. World J Surg Oncol， 2011， 9： 87.
［30］	Li JL，Wang ZL，Su L，et al. Breast lesions with ultrasound imaging-histologic discordance at 16-gauge core needle biopsy：can re-biopsy with 10-gauge vacuum-assisted system get definitive diagnosis？［J］. Breast， 2010， 19（6）： 446-449.
［31］	He Z， Zhou Y， Wang F， et al. Clinical value of postoperative sentinel lymph node biopsy[J]. Ann Transl Med， 2019，7（22）:683.

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