Core Needle Biopsy Rate for New Breast Cancer Diagnosis
Core Needle Biopsy Rate for New Breast Cancer Diagnosis
Objective: The purpose of this study is to evaluate the rate of minimally invasive biopsy for diagnosis of breast cancer at an interdisciplinary breast center.
Background: Percutaneous core needle biopsy (CNB) is optimal for minimizing surgery for the diagnosis of benign and malignant lesions of the breast while preserving surgery for definitive resection. Core needle biopsy increases patient satisfaction and reduces the cost of diagnosis and treatment. Despite the endorsement of CNB by many professional organizations, the literature documents underutilization.
Methods: Institutional review board approval was obtained. An audit of a single institution's prospectively maintained cancer databases was performed for all breast cancers diagnosed in 2007 and 2008. Methods of diagnosis included image-guided and freehand-guided CNB, image-guided vacuum assisted needle biopsy, image-guided fine needle aspiration, punch biopsy, and open surgical biopsy.
Results: Three hundred sixty new breast cancers were diagnosed in 2007 and 2008. Malignancywas diagnosed by minimally invasive techniques in 350/360 (97%) cancers.
Conclusion: A very high rate of accurate tissue diagnosis of breast cancer by minimally invasive techniques is achievable.
In 2001, an interdisciplinary panel of breast cancer experts held the first International Consensus Conference on breast cancer and issued a statement that "percutaneous tissue acquisition techniques should be available for appropriately selected patients." Four years later, in 2005, a similar panel concluded that there are relatively few individuals inwhom an open biopsy is needed, and minimally invasive breast biopsy "should be available for all image-detected lesions." Multiple other professional organizations, including the American College of Radiology and the American Society of Breast Surgeons, have endorsed similar policies. In 2009, the third International Consensus Conference convened and issued a report lamenting that "an alarming 35% of initial diagnostic breast biopsies in the United States are still done using open surgical techniques." This panel of experts reiterated that "percutaneous needle biopsy represents 'best practice' and should be the new 'gold standard' for initial diagnosis" and should essentially "replace open biopsy in this role."
Inevitably, techniques for tissue diagnosis are becoming ameasure of quality of breast care. Although many North American professional organizations have been reluctant to set a target goal, some have suggested an acceptable open biopsy rate of less than 10% for diagnosis of breast cancer, with less than 5% being preferable. In Europe a "minimum standard" of 70% of new cancer diagnoses made by needle techniques has been endorsed, with an "expected" rate of 90%. The argument favoring minimally invasive tissue acquisition is compelling. First, the vast majority of image detected lesions are benign, and percutaneous biopsy eliminates the need for surgery for many benign lesions when there is concordance among clinical history, physical examination, imaging, and needle biopsy pathology. At the same time, preoperative identification of breast malignancy by minimally invasive techniques is equally as accurate as open surgical biopsy, and it optimizes operative planning. Core needle biopsy (CNB) may obviate the need for repeat surgical interventions, reduce the associated morbidity of surgical biopsy, and improve cosmesis. Furthermore, the cost of diagnosis and treatment is reduced. In addition, percutaneous biopsy affords preoperative staging and tumor marker assessment; discussion of neoadjuvant options, breast conserving therapy, and informed consent; and preoperative interdisciplinary consultation with Medical Oncology, Radiation Oncology, and Plastic Surgery colleagues. This practice reflects a patient centered approach to care and enhances patient satisfaction.
In this study, we first sought to document our institutional success rate for achieving the diagnosis of breast cancer by minimally invasive techniques. Secondly, we sought to report other measures of quality regarding CNB, such as pain control, the effect on clinical examination, and the subsequent timeliness of treatment after CNB to provide a more comprehensive analysis of CNB than offered in other studies. Lastly, we reviewed all patients undergoing CNB during our study period that had a benign finding on CNB. Follow-up was established in these patients to determine whether cancers were missed on CNB and to fully describe the performance metrics of minimally invasive breast biopsy.
Abstract and Introduction
Abstract
Objective: The purpose of this study is to evaluate the rate of minimally invasive biopsy for diagnosis of breast cancer at an interdisciplinary breast center.
Background: Percutaneous core needle biopsy (CNB) is optimal for minimizing surgery for the diagnosis of benign and malignant lesions of the breast while preserving surgery for definitive resection. Core needle biopsy increases patient satisfaction and reduces the cost of diagnosis and treatment. Despite the endorsement of CNB by many professional organizations, the literature documents underutilization.
Methods: Institutional review board approval was obtained. An audit of a single institution's prospectively maintained cancer databases was performed for all breast cancers diagnosed in 2007 and 2008. Methods of diagnosis included image-guided and freehand-guided CNB, image-guided vacuum assisted needle biopsy, image-guided fine needle aspiration, punch biopsy, and open surgical biopsy.
Results: Three hundred sixty new breast cancers were diagnosed in 2007 and 2008. Malignancywas diagnosed by minimally invasive techniques in 350/360 (97%) cancers.
Conclusion: A very high rate of accurate tissue diagnosis of breast cancer by minimally invasive techniques is achievable.
Introduction
In 2001, an interdisciplinary panel of breast cancer experts held the first International Consensus Conference on breast cancer and issued a statement that "percutaneous tissue acquisition techniques should be available for appropriately selected patients." Four years later, in 2005, a similar panel concluded that there are relatively few individuals inwhom an open biopsy is needed, and minimally invasive breast biopsy "should be available for all image-detected lesions." Multiple other professional organizations, including the American College of Radiology and the American Society of Breast Surgeons, have endorsed similar policies. In 2009, the third International Consensus Conference convened and issued a report lamenting that "an alarming 35% of initial diagnostic breast biopsies in the United States are still done using open surgical techniques." This panel of experts reiterated that "percutaneous needle biopsy represents 'best practice' and should be the new 'gold standard' for initial diagnosis" and should essentially "replace open biopsy in this role."
Inevitably, techniques for tissue diagnosis are becoming ameasure of quality of breast care. Although many North American professional organizations have been reluctant to set a target goal, some have suggested an acceptable open biopsy rate of less than 10% for diagnosis of breast cancer, with less than 5% being preferable. In Europe a "minimum standard" of 70% of new cancer diagnoses made by needle techniques has been endorsed, with an "expected" rate of 90%. The argument favoring minimally invasive tissue acquisition is compelling. First, the vast majority of image detected lesions are benign, and percutaneous biopsy eliminates the need for surgery for many benign lesions when there is concordance among clinical history, physical examination, imaging, and needle biopsy pathology. At the same time, preoperative identification of breast malignancy by minimally invasive techniques is equally as accurate as open surgical biopsy, and it optimizes operative planning. Core needle biopsy (CNB) may obviate the need for repeat surgical interventions, reduce the associated morbidity of surgical biopsy, and improve cosmesis. Furthermore, the cost of diagnosis and treatment is reduced. In addition, percutaneous biopsy affords preoperative staging and tumor marker assessment; discussion of neoadjuvant options, breast conserving therapy, and informed consent; and preoperative interdisciplinary consultation with Medical Oncology, Radiation Oncology, and Plastic Surgery colleagues. This practice reflects a patient centered approach to care and enhances patient satisfaction.
In this study, we first sought to document our institutional success rate for achieving the diagnosis of breast cancer by minimally invasive techniques. Secondly, we sought to report other measures of quality regarding CNB, such as pain control, the effect on clinical examination, and the subsequent timeliness of treatment after CNB to provide a more comprehensive analysis of CNB than offered in other studies. Lastly, we reviewed all patients undergoing CNB during our study period that had a benign finding on CNB. Follow-up was established in these patients to determine whether cancers were missed on CNB and to fully describe the performance metrics of minimally invasive breast biopsy.
