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Needle biopsies safer and just about as good at diagnosing breast cancer, say authors of mammogram advice

December 15, 2009 |  1:03 pm

The federal government's Agency for Healthcare Research and Quality, apparently undaunted by the controversy it kicked up last month over mammograms, has waded back into the breast-cancer thicket with new advice on how best to distinguish benign breast lumps from possible malignancies.

In a report released today, the arm of the Health and Human Services Department that is charged with comparing the effectiveness of competing medical interventions said that core-needle biopsies are just as good as the method long considered the "gold standard" of evaluating suspicious breast lesions: open surgical removal.

The AHRQ report reviews the pros and cons of both methods of evaluating breast lumps and concludes that "certain core-needle biopsies could distinguish between benign and malignant lesions approximately as accurately" as open surgical biopsy. Needle biopsies carry "a much lower risk of severe complications," than does surgical excision of breast tissue -- including a far higher likelihood that, if cancer is diagnosed after a surgical biopsy, the patient "will undergo multiple surgical procedures during treatment."  

Core-needle biopsies, routinely done under local anesthesia, use a sharp-edged cutting needle. The needle is inserted through a puncture in the breast and withdraws a "core sample" of breast tissue for further inspection by a pathologist. In a surgical biopsy, typically done under slightly heavier anesthesia, the surgeon sometimes cuts out the suspicious lump in its entirety, plus some normal tissue surrounding it. If the lump is larger, an "incisional biopsy" is often done to gain a "slice" of a suspicious lump for investigation (For a detailed description, see here.). 

The group said that the accuracy of core-needle biopsy has been greatly improved in recent years with the addition of stereotactic and ultrasound guidance, as well as with vacuum assistance technologies. Those allow a physician to home in much more accurately on the area of suspicion, and to withdraw more efficiently a representative sampling of cells to be investigated.

In addition to being roughly as accurate and less risky, core-needle biopsy is less costly than surgical removal and "generally is preferred by patients." And because about one in 10 women who have suspicious lumps in their breast biopsied proves to have breast cancer, the less invasive, less costly core-needle biopsy seems the better choice in most cases, the group concluded.

Have you or your physician found a lump in your breast? Learn more here.

-- Melissa Healy

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