New guidelines for breast biopsies

In an effort to improve the diagnosis of breast cancer, an international panel of 23 expert surgeons, radiologists, pathologists, and oncologists recently recommended expanding the roles of minimally invasive needle and sentinel node biopsies and severely limiting the role of open surgical biopsies, citing that almost one third of the 1.7 million breast biopsies performed in the United States are still done surgically.

The panel emphasized that minimally invasive techniques must be used whenever possible because eight of 10 breast biopsies are performed for benign reasons. Minimally invasive needle biopsies not only help women without disease avoid unnecessary surgery, but they allow for better surgical planning in women with disease and provide significant cost-savings.

The panel also agreed that vacuum-assisted needle biopsies are preferred for microcalcifications because of their high accuracy and more complete removal of tissue than that of conventional needle biopsies. They also agreed that sentinel lymph node biopsy, during which only one to three lymph nodes are removed, is preferred to traditional axillary node dissection during which 15 to 30 lymph nodes are removed, for accurately staging image-detected breast cancer in most patients. Sentinel node biopsy results in fewer complications including lymphedema, and offers a faster recovery.

Silverstein MJ, Lagios MD, Recht A, et al. Image-detected breast cancer: state of the art diagnosis and treatment. J Am Coll Surg. 2005;201:586-597.