Examining core needle biopsy vs fine needle aspiration in a tertiary cancer centre

Abstract

Introduction: Minimally invasive biopsies such as core needle biopsy (CNB) and fine needle aspiration (FNA) play a fundamental role in cancer diagnosis and molecular profiling. With the advent of novel therapeutic agents and an increasing number of biomarkers, the demand for tissue acquisition and further ancillary testing is growing. Here we compare CNB and FNA in lung cancer and pantumour at a UK tertiary cancer centre. Methods: A retrospective review was conducted for standard of care and research patients who had undergone a minimally invasive biopsy at The Christie NHS Foundation Trust between January 2017 and April 2019. Data collected included: adequacy for diagnosis, adequacy for ancillary testing, scheduling and complication rates. Fisher’s exact test was used to compare categorical variables. Results: 445 biopsies were performed including 61.1% (272/445) CNB vs. 38.9% (173/445) FNA. In the lung cohort (n=49), there was no statistical difference between adequacy yield for CNB vs FNA (94.6% vs. 85.7%, respectively; p=0.41), nor for ancillary testing (100% CNB vs 75% FNA; p 0.15). In pan tumour analysis, CNB was adequate for diagnosis in 85% vs. 79.2% FNA (p=0.16), and was associated with a significant increased adequacy for ancillary testing (98.7% CNB vs 76.9% FNA; p<0.0001). There was no significant difference in complication rates between CNB and FNA, 1.1% vs. 0.6%. Conclusion: CNB is associated with an increased likelihood that a sample provides sufficient material for ancillary testing. Whilst lung cancer-specific analysis yielded no statistically significant outcomes, incongruency to the pan-disease results may be attributed to smaller sample size. Our results demonstrate that CNB is safe and should be considered as the preferred technique where possible for minimally invasive biopsies.