This Position Statement is based on:
- a review of high-level published peer-reviewed, clinical evidence (01 January 2000 to 31 July 2018) relating to the use of FNA and core biopsy in the context of mammographically-detected breast abnormalities;
- a review of recent national and international guidelines on the use of FNA and core biopsy for mammographically-detected breast abnormalities;
- an analysis of National Accreditation Standard (NAS) data from the BreastScreen Australia program (2004-2015); and
- the clinical expertise of a multidisciplinary, Expert Advisory Group established by Cancer Australia to provide expert input into the development of the Position Statement.
The scope of this Position Statement encompasses the use of FNA and core biopsy in the BreastScreen Australia Program.
The research questions guiding the high-level review of recent evidence were:
- In women with suspicious lesions detected by breast cancer screening programs,1 what is the diagnostic accuracy, reliability and reproducibility of FNA compared with core biopsy for the detection of (a) DCIS or (b) invasive breast cancer?
- In women with suspicious lesions detected by breast cancer screening programs,1 what are the clinical consequences of FNA compared with core biopsy for the detection of (a) DCIS or (b) invasive breast cancer?
Searches were undertaken in EMBASE and Medline, the Cochrane Library, the websites of peak cancer and health technology assessment agencies, and scanning of the reference lists of included studies for additional relevant studies that might not have been identified in the formal literature search. The search cut-off date was 31 July 2018.
Recent Australian and international guidelines and Position Statements were also sourced.
An analysis of BreastScreen Australia data was undertaken to provide local context. The data analysis is seen as ancillary to the evidence from the high-level review of clinical evidence. The data analysis addressed the following questions:
Question 1: What are the trends in use of FNA and core biopsy in the BreastScreen Australia program?
Question 2: How have FNA and core biopsy performed, as related to their respective National Accreditation Standard (NAS)?
Question 3: What are the differences in BreastScreen Australia Screening and Assessment Service (SAS) performance outcomes as related to their use of FNA and core biopsy?
A multidisciplinary Expert Advisory Group was established by Cancer Australia to oversee the development of the Position Statement, provide expert opinion into the development of evidence-based content, and provide advice on the recommendations of the Position Statement. The Expert Advisory Group included representatives who work within the BreastScreen Australia program from the Royal College of Pathologists of Australasia, the Royal Australian and New Zealand College of Radiologists, Breast Surgeons of Australia and New Zealand, and the Australasian Society of Breast Physicians. The Expert Advisory Group also included consumer representatives from the Breast Cancer Network Australia, a BreastScreen Australia jurisdictional Program Manager representative from the BreastScreen Australia National Quality Management Committee, an epidemiologist, as well as observers from the Department of Health and Cancer Australia.
For further information refer to the Technical Report: Position Statement on the use of fine needle aspiration (FNA) and core biopsy of the breast in the BreastScreen Australia program: High level review of recent evidence and existing national and international guidelines.
1 Breast cancer screening includes routine and population-based breast cancer screening