When a woman needs a biopsy to determine whether a breast abnormality is benign or malignant, she is usually directed to one of two procedures. Which one is best in terms of accuracy and complications is unlikely to be discussed during the usual doctor/patient encounter. It is, however, the subject of a new review that concluded in favor of the core-needle biopsy because results “seem to be almost as accurate as open surgical biopsy, with lower complication rates.” The indefinite choice of words (“seem to be”) can be attributed to the fact that the 84 studies included in this review were judged to be of low quality (though the best of what has been done so far).

A core-needle biopsy can be done with equal success with either stereotactic- or ultrasonography-guidance. The review’s finding was based on studies that compared the diagnoses of women given the minimally invasive core-needle biopsy with the diagnoses of the same women subsequently given either an open surgical biopsy or a radiologic follow-up.

Complications can be: bleeding severe enough to require treatment; pain severe enough to require pain medication; and a hematoma that requires treatment. The complication rate for core-needle biopsy was extremely low—less than 1%; whereas the complication rate for the surgical open biopsy was in the range of 2% to 10%.

This review was led by Wendy Bruening, PhD, ECRI Institute in Plymouth Meeting, PA, and published online first at the Web site of Annals of Internal Medicine. It was funded by the U.S. Agency for Healthcare Research & Quality.

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The findings of this review support the outrage expressed one year ago in an editorial by surgeon Melvin J. Silverstein, MD. He was commenting on a new study showing that nearly 40% of the breast biopsies done at one prestigious academic medical center were open surgical biopsies. He estimated that well over 90% of women with suspicious breast abnormalities are appropriate candidates for a needle biopsy and described the circumstances that indicate an open surgical biopsy is appropriate. To read our 2009 interview with Dr. Silverstein, click here.

Maryann Napoli, Center for Medical Consumers©

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