Feature Story

Nonsurgical method for diagnosing breast cancer is safe and nearly as effective as surgical biopsy

Some methods of minimally invasive biopsy for breast cancer are nearly as accurate as surgical biopsy, but have much less risk of harm, according to a new report funded by the Agency for Healthcare Research and Quality (AHRQ).

The report compares traditional surgical biopsies with various types of "core needle biopsies," which involve removing tissue through a special large hollow needle inserted through the skin. The report, initiated in 2007, will provide important information so that women and their doctors can work together to make the best possible diagnostic choice for each individual patient.

Based on reviews of published scientific evidence to gauge the effectiveness, risk, and impact of core needle biopsies on patients, the report found that certain core needle biopsies could distinguish between malignant and benign lesions approximately as accurately as open surgical biopsy, which is commonly considered the "gold standard" method of evaluating suspicious lesions. Core needle biopsies also have a much lower risk of severe complications than open surgical procedures.

The report also found that women who are initially diagnosed with breast cancer by surgical biopsy are more likely to undergo multiple surgical procedures during treatment than women who are initially diagnosed with breast cancer by core needle biopsy. The report does not recommend changes to Federal policy or to decisions regarding insurance coverage, nor does it make clinical recommendations regarding under what circumstances open surgical biopsies or core needle biopsies should be pursued. These decisions should be made by a patient in consultation with her physician.

Open surgical biopsies, which involve removing a sample of tissue from the suspicious area through a surgical incision, are highly accurate. The procedure may be performed under general anesthesia, sedation plus local anesthesia, or local anesthesia only. While generally considered safe, open surgical biopsies are surgical procedures that, like all surgeries, carry a small amount of risk. Given that only a fraction of women who undergo breast biopsy procedures are diagnosed with cancer, use of traditional biopsy leads to large numbers of women who do not have cancer undergoing an invasive surgical biopsy.

In contrast, a core needle biopsy is a procedure that removes breast tissue through a hollow core needle inserted through the skin. The procedure is usually performed under local anesthesia. Multiple core-needle samples may be taken from the suspicious area. Because it is less invasive, core-needle biopsy costs less than open surgical biopsy, consumes fewer resources, and generally is preferred by patients, according to the report. It also noted that recent technological improvements to core needle biopsy, including stereotactic guidance, ultrasound guidance, and vacuum assistance, have improved the method's accuracy.

The report, Comparative Effectiveness of Core Needle and Open Surgical Biopsy for the Diagnosis of Breast Lesions, was prepared by the ECRI Institute's Evidence-based Practice Center under contract to AHRQ's Effective Health Care Program. The program is intended to provide information in order to help patients, doctors, nurses, and others choose the most effective treatments. Information, including the new report and summary guides for clinicians and patients, can be found at http://www.effectivehealthcare.ahrq.gov.

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