Needle Biopsies as Accurate as Surgical Biopsies Detecting Breast Cancer

Core needle biopsies for diagnosing breast cancer are nearly as accurate as a surgical biopsy but entail less risk, according to a new study.

Researchers at the ECRI (Plymouth Meeting, PA, USA) evidence-based practice center examined databases, including Medline and EMBASE, from 1990 to September 2009, for studies that compared core-needle biopsy diagnoses with open surgical diagnoses or clinical follow-up. A total of 33 studies of stereotactic automated gun biopsy, 22 studies of stereotactic vacuum-assisted biopsy, 16 studies of ultrasonography (US)-guided automated gun biopsy, 7 studies of US-guided vacuum-assisted biopsy, and 5 studies of freehand automated gun biopsy that met the inclusion criteria were abstracted by one of three researchers, verified by the primary investigator, and the data were then synthesized.

The results of the analysis found low-strength evidence that core-needle biopsies conducted under stereotactic guidance with vacuum assistance distinguished between malignant and benign lesions with an accuracy that is similar to that of open surgical biopsy; US-guided biopsies were also very accurate. The risk of severe complications was found to be lower with core-needle biopsy than open surgical procedures. Moderate-strength evidence showed that women in whom breast cancer was initially diagnosed by core-needle biopsy were more likely than women with cancer initially diagnosed by open surgical biopsy to be treated with a single surgical procedure. The researchers concluded that stereotactic- and US-guided core-needle-biopsy procedures seem to be almost as accurate as open surgical biopsy, with lower complication rates. The study was published ahead of print on December 14, 2009, in the Annals of Internal Medicine.

"One challenge of providing appropriate care for patients is finding balance between the accuracy of a test or procedure and causing the least harm and burden to patients,” said Carolyn M. Clancy, M.D., director of the U.S. Agency for Healthcare Research and Quality (AHRQ, Rockville, MD, USA), who commissioned the research. "This report indicates that core-needle biopsy may strike that balance in many instances. Patients should continue to speak to their doctor when making important decisions about testing, and use all available information to make the decision that is right for them.”

Core-needle biopsy is a procedure usually performed under local anesthesia that involves removing small samples of breast tissue through a hollow core needle inserted through the skin. The suspicious lesion may be located by palpation or by imaging via stereotactic mammography, US, or magnetic resonance imaging (MRI). Multiple core-needle samples may be taken from the suspicious area. A variant on core-needle biopsy is vacuum-assisted biopsy. After locating the suspicious area, the probe of the device is inserted into the suspicious area; the device then uses vacuum suction to help remove tissue samples.

Related Links:
ECRI
U.S. Agency for Healthcare Research and Quality