Most women should undergo a needle biopsy for breast cancer diagnosis, but some surgeons opt for a more invasive procedure instead, according to a new study.
The difference may be a matter of surgeon experience, researchers say, so many women could benefit if surgeons were trained and encouraged to opt for the needle method more often.
“Needle biopsy really is the standard of care,” said senior study author Dr. Benjamin D. Smith of The University of Texas MD Anderson Cancer Center in Houston.
“Having a three or four centimeter (surgical) incision in the skin is going to hurt more and take longer to heal than inserting a needle,” Smith told Reuters Health by phone. “Excisional biopsy has more complications than needle biopsy.”
When a woman has a suspicious lump in her breast, usually detected by a mammogram, the way to determine if it is cancer is to take a sample of tissue from the lump and test it.
Diagnostic radiologists are trained to use ultrasound or mammography to guide a large needle through the breast to take the sample, and surgeons can also use a needle, albeit without the extra guidance equipment.
The surgical approach, is sometimes called an “open biopsy” because it requires an incision to access the lump. The procedure is also known as excisional biopsy.
If the lump is cancerous, valuable information about its nature can be gleaned from a biopsy, the study authors point out. But rather than having two surgeries, one to diagnose the cancer and another to remove it, a needle biopsy can provide that initial information in most cases.
To see how often women were getting needle biopsies versus the surgical kind, and what factors predicted the type of biopsy a woman got, Smith and his coauthors looked at the diagnostic histories of almost 90,000 women with breast cancer using Medicare data for the years 2003 to 2006.
The women were at least 66 years old and had undergone both breast-conserving surgery and radiation to treat their cancers. About two-thirds of the women had a needle biopsy, including those who had a related technique, known as a core biopsy.
Of the women who had consulted with a surgeon before the biopsy, only 54 percent subsequently had a needle biopsy.
Surgeons without board certification, who were trained outside the United States or who were not specialized in surgical oncology were less likely to have patients undergo a needle biopsy, according to