Surgical Breast Biopsy Has High Reexcision Rate

SAN ANTONIO-Surgical biopsy for the initial evaluation of breast lesions should be discouraged, according to Stephen D. Edge, MD, of Roswell Park Cancer Institute, Buffalo, New York, who presented a study comparing biopsy techniques at the 28th Annual San Antonio Breast Cancer Symposium (abstract 12).

The study evaluated data from the National Comprehensive Cancer Network Breast Cancer Outcomes Database, which includes 6,282 women with stage 0 (ductal carcinoma in situ), I, or II disease diagnosed between 1997 and 2002. Investigators compared outcomes between patients who underwent surgical vs needle biopsies (fine-needle aspiration or vacuum-assisted biopsy or core biopsy, with or without image localization) for suspicious lesions.

Dr. Edge pointed out that surgical biopsy removes the entire lesion, but patients often require additional surgery on a separate day. Needle biopsy allows for patients with benign lesions to avoid surgery, and for those diagnosed with cancer it allows time for counseling and may also reduce the need for repeat surgery. The study's hypothesis was that needle biopsy would require fewer operations and fewer total trips to surgery (breast plus axillae), and would require less time for completion of the diagnostic and surgical phases of breast cancer care.

The need for reexcision was the primary endpoint of the study: 55% had an initial needle biopsy, 42% had a surgical biopsy, and 3% had a one-stage procedure (breast-conserving surgery with axillary surgery or mastectomy without a prior surgical or needle biopsy).

The analysis showed that 92% of women having surgical biopsies required reexcision, compared with 23% who had needle biopsies. "This was highly significant," Dr. Edge said. The results were consistent across eight NCCN centers, except for one center that had a reexcision rate of around 20% or less for both biopsy approaches.

"The overall rate of reexcision included complete mastectomy as a reexcision. However, this striking relationship between reexcision and initial biopsy type was seen among women who received breast-conserving therapy and those who had mastectomy. The difference was also seen regardless of whether image location technology was used," he said.

The need for reexcision affected the total number of breast operations. In a multivariate analysis, the average number of operations required to complete the surgery was 1.31 for needle biopsies and 2.14 after surgical biopsies, for a mean difference of 0.83 (P < .0001).

Patients requiring reexcision also had a longer time to complete breast-conserving surgery. From the time of initial biopsy, the overall number of elapsed days was 29 in the group not requiring reexcision, compared with 45 days for those requiring reexcision, he said.

Dr. Edge said the results suggest that "the use of surgical biopsy for initial evaluation should be discouraged" and that "needle biopsy may be a useful quality benchmark for cancer care."