Preoperative needle breast biopsies can lead to improved treatment outcomes

Chicago: Women suspected of having breast cancer now have more reasons to be diagnosed with a needle biopsy instead of a traditional open surgical biopsy. Besides avoiding the risks and discomfort of an open surgical procedure, needle biopsies can also lead to improved treatment outcomes according to findings from a new study published in the October issue of the Journal of the American College of Surgeons.

Breast cancer is the number one form of cancer diagnosed in women in the United States, according to the U.S. Centers for Disease Control and Prevention. [1] In 2012, more than 226,000 women will be diagnosed, according to estimates from the National Cancer Institute. [2] Findings from an open biopsy or needle biopsy can confirm whether a suspicious breast lesion is actually malignant. During an open biopsy, an operation is performed to remove the concerning breast tissue and then it is examined in the laboratory to determine the presence of any malignant cells. This open procedure typically involves a trip to the operating room, a full surgical incision, and some form of anesthesia. However, a percutaneous needle biopsy procedure, allows physicians to locate the breast lesion without actually opening the breast. Instead, they use imaging techniques and extract a sample of the concerning tissue through a needle. This minimally invasive approach can be performed using a topical anesthetic and takes place in the office setting or radiology suite. There is less discomfort and quicker recovery time compared with open surgical biopsies.

Despite the less invasive nature of needle biopsy, "some physicians are still doing open biopsy, perhaps because of limited resources or lack of awareness. Needle biopsies require special instruments, techniques, and skills that may not be available at all treatment sites," explained Ted A. James, MD, FACS, associate professor of surgery at the University of Vermont College of Medicine and lead author of the study. The advantage of the needle biopsy approach is that women may avoid an operation if the results are benign, and can get the benefit of appropriate preoperative planning if cancer is detected. "There are certainly some legitimate reasons to do an open biopsy, such as when the lesion is in a difficult position for the needle to reach. But the open approach should only be used for about 10 percent of cases, Dr. James estimates. "A needle biopsy is a more efficient, less invasive way to get the same diagnosis," he said.

Dr. James and colleagues investigated whether better patient outcomes could be added to the list of needle biopsy advantages. They analyzed data on 1,135 patients who had been diagnosed with breast cancer and treated at hospitals in Vermont between 1998 and 2006. Patient data came from the Vermont Breast Cancer Surveillance System (VBCSS), the Vermont Cancer Registry (VCR), and the Centers for Medicare and Medicaid Services (CMS) enrollment and claims data.

None of the patients had a previous history of breast cancer, and 62.8 percent were diagnosed after needle biopsies. Patient data included the tumor's size, stage, and estrogen receptor status. The surgeons also looked at education level and whether the patients were rural or urban residents, just in case there were correlations between socioeconomic status and biopsy procedure.