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During an open surgical breast biopsy, patients are often put under general anesthesia, and an incision in the breast is made to remove a tissue sample of the abnormal lesion for examination by pathologists. The incision must then be sutured, which poses risks for infection, bleeding, and scarring for patients. Needle breast biopsy is an effective alternative to the open approach. With this technique, only local anesthesia is necessary. Patients experience much less discomfort, quicker recoveries, and minimal pinpoint scarring. The procedure also saves time and money as open surgical biopsy can cost double or triple the amount of needle biopsy.

With these facts in mind, the American College of Surgeons (ACS) Consensus Conference published guidelines in 2005 sanctioning minimally invasive biopsy as the recommended procedure for diagnosing image-detected breast lesions. During this meeting, a consensus group I chaired collectively favored a strong supportive statement about minimally invasive breast biopsy. We concluded that needle biopsy was the optimal initial tissue acquisition method and procedure of choice for image-detected abnormalities. There are relatively few patients for whom open surgical breast biopsy should be the initial diagnostic procedure. In 2006, the American Society of Breast Surgeons issued a statement in accordance with these ACS guidelines.

Data Show That Low Compliance Persists

Despite the documented benefits of needle biopsy, a study published in the January 2009 Journal of the American College of Surgeons revealed that nearly 40% of patients are still receiving open surgical breast biopsy as their initial diagnostic procedure. Considering that only about 20% of the 1.6 million abnormalities detected by mammography turn out to be cancer, the study suggests that many women with benign breast lesions are undergoing unnecessary invasive diagnostic surgery.

It’s distressing that so many women are going straight to the operating room (OR) for a diagnostic breast biopsy. Relatively few patients need to undergo an open surgical biopsy as their initial diagnostic procedure. For breast cancer, the OR should be reserved for treatment rather than diagnosis. Medical centers and hospitals need to start considering needle biopsy as the standard of care for initial tissue acquisition in both palpable and imagedetected abnormalities. This type of policy should be prevalent in more institutions throughout the country.

There are, of course, exceptions where lesions simply cannot be biopsied with a needle because of the position or other factors, but this occurs in less than 5% of cases. A definitive diagnosis of cancer made using a needle biopsy permits optimal preoperative workup and planning. It gives detailed information about the nature of the tumor. When surgeons know the lesion is cancer before operating, they can more precisely plan the optimal location of the incisions for breast conservation or oncoplastic resection.

How Can We Achieve Higher Compliance?

To improve compliance, we need to better inform patients about the benefits of minimally invasive breast biopsy. Patients must be encouraged to become their own healthcare advocates; they should educate themselves about available biopsy options and seek out surgeons or radiologists that perform needle biopsies. Referring physicians play an extremely important role; they need to take the time to educate patients and offer guidance about available diagnostic biopsy options before providing referrals. Finally, surgeons must continue to aim for the goal of going to the OR just once to perform the correct therapeutic—not diagnostic—procedure.

Melvin J. Silverstein, MD, FACS, has indicated to Physician’s Weekly that he has no financial disclosures to report.