AIM: Core-needle biopsy nearly as accurate, safer than surgical biopsy for breast cancer
Stereotactic- and ultrasonography-guided core-needle biopsy procedures may be considered to be nearly as accurate as open surgical biopsy, with lower complication rates for average-risk women suspected of having breast cancer, according to an article published in the Feb. 16 issue of Annals of Internal Medicine.

Wendy Bruening, associate director of the ECRI Institute Evidence-based Practice Center in Plymouth Meeting, Pa., and colleagues sought to compare accuracy, as well as the harm of different breast biopsy methods. The authors utilized various databases, including MEDLINE and EMBASE beginning in 1990 to 2009, to compare the diagnosis results of patients who underwent the minimally invasive core-needle biopsy with the diagnoses of the same women subsequently given either an open surgical biopsy-considered by many physicians to be the “gold standard” of breast cancer detection methods, or a radiologic follow-up.

The investigators also focused their analysis on determining the extent of false-negative errors and  sensitivity rates for both diagnosis methods.

Bruening and colleagues included 33 studies of stereotactic automated gun biopsy; 22 studies of stereotactic-guided, vacuum-assisted biopsy; 16 studies of ultrasonography-guided, automated gun biopsy; seven studies of ultrasonography-guided, vacuum-assisted biopsy; and five studies of freehand automated gun biopsies for their review.

Ultrasonography-guided biopsies were found to be very accurate when compared to open surgical biopsy, as well as core-needle biopsies conducted under stereotactic guidance with vacuum assistance in distinguishing between malignant and benign lesions, wrote the authors.

Additionally, the authors reported moderate-strength evidence that showed women in whom breast cancer was initially diagnosed by core-needle biopsy were found to be more likely than women with cancer initially diagnosed by open surgical biopsy to be treated with a single surgical procedure.

Bruening and colleagues noted that the risk for severe complications is lower with core-needle biopsy than with open surgical procedures, with complications including scarring, bleeding severe enough to require treatment, pain severe enough to require pain medication and a hematoma requiring treatment.

The complication rate for core-needle biopsy was noted to be less than 1 percent, compared to the rate of complication for open surgical biopsy, which was between 2 and 10 percent.

“Most women undergoing breast biopsy are found not to have cancer,” said Bruening, who noted that 20 to 30 percent of women are found to have cancer post-biopsy, and that no biopsy method is 100 percent accurate. “Exposing large numbers of women who do not have cancer to invasive surgical procedures may be considered an undesirable medical practice. Our findings were that any core needle biopsy has a lower risk of complications and [core-needle biopsy] almost as accurate as surgical biopsy."

The authors wrote that women should talk with their doctors about what biopsy procedure is most appropriate for their case, and whether the minimally invasive core-needle biopsy, performed under local anesthesia, is an option.

In determining whether core-needle biopsy is accurate enough for their case, physicians may take the individual woman’s estimated pre-biopsy chance of having cancer (an estimate derived from mammography results and other pre-biopsy exam information) and an individual woman’s desire to avoid risk into consideration, concluded the authors.