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Core needle biopsy nearly as good as open biopsy for diagnosing breast lesions

Reuters Health and The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Core needle biopsies seem almost as accurate as open biopsy in detecting breast cancer, and less prone to complications, a meta-analysis has found.

This finding was true whether the biopsy was stereotactic or ultrasound-guided — although the authors admit the supporting evidence was not strong.

“The relative accuracy of different methods of performing core needle biopsy, and their accuracy in comparison to open surgical biopsy in diagnosing suspicious breast lesions, is unclear,” Dr. Karen Schoelles, from the ECRI Institute, Plymouth Meeting, Pennsylvania, and colleagues note. “If a sufficiently accurate method of performing minimally invasive core-needle biopsies exists, its use may enable many women to avoid surgery altogether and reduce the number of surgical procedures women with malignancies must undergo.”

The findings, reported in the December 15th issue of the Annals of Internal Medicine, stem from a review of studies that compared core-needle biopsy diagnoses with open surgical diagnoses or clinical follow-up.

In searching MEDLINE and EMBASE from 1990 to September 2009, the authors identified 33 studies of stereotactic automated gun biopsy, 22 of stereotactic vacuum-assisted biopsy, 16 of ultrasound-guided automated gun biopsy, 7 of ultrasound-guided vacuum-assisted biopsy, and 5 of freehand automated gun biopsy.

Core-needle biopsy under stereotactic guidance was about as accurate as open biopsy in diagnosing breast lesions, although, as noted, the strength of evidence was low. High accuracy rates were also seen with ultrasound-guided biopsy.

The benefit of core-needle biopsy is in its safety profile. Less than 1% of patients who undergo core-needle biopsy experience a severe complication compared with 2% to 10% of those who undergo open surgical biopsy, the results show.

According to the report, women who had breast cancer diagnosed with core needle biopsy were usually able to have their malignancy treated with a single surgical procedure. Women who underwent open surgical biopsy were 13.7-times more likely than these women to require more than one surgical procedure to treat their cancer.

“Based on currently available evidence, it appears reasonable to substitute certain core needle biopsy procedures for open surgical biopsy given the comparable sensitivity and lower complication rates for some of the percutaneous methods,” the authors conclude.

Ann Intern Med 2009.