Core Needle Biopsy (CNB): A Modern, Safe, and Effective Diagnostic Method
The Core Needle Biopsy (CNB) is a modern, safe and effective diagnostic method for the evaluation of suspicious lesions in the breast. It is used to obtain small cylindrical tissue samples, which are sent for microscopic examination to the pathology laboratory. In relation to needle aspiration (FNA), it offers bigger diagnostic accuracy and allows the differential diagnosis between benign and malignant lesions.
How is Core Needle Biopsy performed?
The procedure is performed in an outpatient clinic, under local anesthesia, and lasts about 15–30 minutes. The needle is inserted through a very small incision in the skin (less than 0.5 cm), which no stitches needed. Depending on the case, a metal buoy (clip) at the biopsy site for future imaging guidance.
How is the lesion located?
The localization method depends on the lesion’s morphology and imaging appearance:
- Palpable lesions: CNB is performed without imaging guidance.
- Ultrasound: Preferred for most non-palpable lesions. It is fast, radiation-free, and allows real-time needle guidance. live needle guidance in real time.
- Mammography or Tomosynthesis: They are used when lesions (such as microcalcifications) are not visible on ultrasound. A biopsy is then performed. stereotactic or tomosynthesis-guided.
- Magnetic Resonance Imaging (MRI): It is used when the suspicious area is only identified on MRI. If it is not possible to image it with ultrasound, then it is performed MRI-guided CNB, a high-cost method applied in selected specialized centers.
What to expect after the biopsy?
Recovery is generally immediate. Most women no painkillers needed and return to their daily activities the very next day. It is possible to experience mild ecchymosis or Hematoma which subside in a few days.
The biopsy results are usually issued within 5–10 days. Depending on the findings, the next phase of monitoring or therapeutic intervention is determined.
Why choose CNB?
The core needle biopsy is the method of first choice for diagnosing suspicious breast lesions, with diagnostic accuracy exceeding 95%It is superior to fine needle aspiration (FNA), as it provides sufficient tissue for complete histological assessment and often prevents the need for surgical biopsy.
For lesions of uncertain malignant potential (B3 category — e.g., atypical hyperplasia, sclerosing adenosis, papillomas), CNB is a crucial diagnostic step and may require additional sampling or surgical excision for full evaluation.
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Bibliography:
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- Youk JH, et al. Missed breast cancers at US-guided core needle biopsy: how to reduce them. Radiographics. 2007;27(3):79-94.
- Lourenco AP, et al. ACR Appropriateness Criteria® Palpable Breast Masses. J Am Coll Radiol. 2021;18(5S):S130-S144.
- Rageth CJ, et al. Second International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions). Breast Cancer Res Treat. 2019;174(2):279-296.
- Bahl M, et al. MRI-guided breast biopsy: a review of technique and results. World J Radiol. 2014;6(7):473-85.
- American College of Radiology. ACR Practice Parameter for the Performance of Ultrasound-Guided Percutaneous Breast Interventional Procedures. 2023.
