A new study has reported that the rate of surgical biopsy compared to needle biopsy to diagnose breast cancer remains higher than accepted guidelines. The study was designed to determine the rate of minimally invasive breast biopsy (percutaneous needle biopsy, or needle biopsy) compared to open surgical breast biopsy (excisional biopsy) in evaluating suspicious breast lesions in Florida. Needle biopsy has become the gold standard for the initial assessment of suspicious breast lesions. To conduct the study, the authors queried the Florida Agency for Health Care Administration outpatient surgery and procedure database for patients who underwent needle biopsy and open surgical biopsy between 2003 and 2008. The study included a total of 172,342 breast biopsies.

Although there was an increase in the use of needle biopsy during the study period, the overall rate of open surgical biopsy was found to remain high (approximately 30%). Lowering the open biopsy rate from 30% to 10% could potentially save more than $37.2 million per year. The authors conclude that the current rate of open surgical breast biopsy remains high, warranting interventions and quality initiatives, which could reduce unnecessary operations for women, improve patient care, and reduce breast health care costs.

Comments concerning the study

Needle biopsies have obvious advantages over surgical biopsies, especially for the majority of women who turn out not to have breast cancer (approximately 80% of breast biopsies are benign). Needle biopsies are safer, less expensive, and less disfiguring. A needle biopsy typical involves only numbing with a local anesthetic, a tiny incision with minimal or no scarring, and low risk of infection. On the other hand, an open surgical biopsy typically involves sedation or general anesthesia, an inch long incision with stitches likely to leave a scar and a noticeable indentation in the breast, as well as having a higher risk of infection.

However, for women who turn out to have breast cancer, needle biopsies provide less information concerning the tumor or tumors. Staging and determining the hormone receptor status may be less accurate in some cases when needle biopsy is used. This is especially important when neoadjuvant treatment (e.g., chemotherapy before surgery to remove the tumor) is planned based on the biopsy results. Therefore, if the likelihood of breast cancer is high based on diagnostic imaging and clinical factors, the potential advantages and disadvantages of a surgical biopsy should be weighed carefully.

For women who have needle biopsies that find breast cancer, there is also a small possibility that tumor seeding along the needle path will occur. Most cancer cells dispersed in such a manner do not survive and radiotherapy appears to be effective for destroying the remainder. However, the needle tract must be part of the radiation field. It is also preferable that any subsequent lumpectomy (or more extensive breast conserving surgery) remove all of the tissue immediately surrounding the biopsy path, if possible. These are simple precautions that normally would not add anything to the cost or difficulty of the procedures. Women who have core needle biopsies should consider keeping track of the location of the entrance points of the needles and discussing the matter with their surgeons and radiologists.