Needle biopsy—the standard of care for diagnosing breast cancer—is underused, and too many patients instead undergo the more invasive excisional biopsy, according to a recent study.
The study also corroborated previous studies that showed needle biopsy reduced the need for multiple breast cancer surgeries.
One advantage of needle biopsy, according to Benjamin Smith, M.D., an associate professor in the Department of Radiation Oncology at The University of Texas MD Anderson Cancer Center and the corresponding author of the study’s report, is that an excisional biopsy can increase the risk for false-negative findings on the sentinel lymph node biopsy, which is used to guide adjuvant treatment.
“Often, the excisional biopsy negatively affects other aspects of breast cancer treatment and is simply a wasteful procedure,” Dr. Smith said. “With this study, we wanted to quantitate the magnitude of that waste on a national scale and identify some of the impacts of that practice pattern on the well-being of patients.”
For the retrospective study, Dr. Smith and his colleagues reviewed Medicare claims of 89,712 patients diagnosed with breast cancer from 2003 to 2007. All the patients were treated with breast-conserving surgery and radiation.
Of the patients, 68.4% underwent a needle biopsy; this rate increased from 60.8% in 2003 to 76.5% in 2007.
Nearly a third of all patients underwent a needle biopsy (usually performed by a radiologist) before consulting with a surgeon. Of the patients who consulted a surgeon before their biopsy, 53.7% underwent a needle biopsy.
The researchers studied the characteristics of patients who consulted surgeons before their biopsy and of the surgeons who were consulted. Patients who lived more than 8.1 miles from a radiologic facility that performs needle biopsies were more likely to consult a surgeon before undergoing a biopsy than were patients who lived closer to such facilities. Among the surgeon characteristics associated with patients’ undergoing excisional biopsy rather than needle biopsy were lack of board certification and low case volume.
“While there are access issues that should be addressed, it’s clear that the surgeon’s role is very important for the patients’ care,” Dr. Smith said.
An important aspect of care, the number of breast cancer surgeries performed per patient, was also studied. Multiple breast cancer surgeries were performed in 69.6% of patients who underwent excisional biopsy but in only 33.7% of those who underwent needle biopsy.
The study’s report was published in July in the Journal of Clinical Oncology.
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OncoLog, August 2014, Volume 59, Issue 8