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Needle biopsy to evaluate breast Ca has best outcomes: surgical biopsy is 'strongly discouraged.'.(News)
SAN ANTONIO -- Needle biopsy for the initial evaluation of breast abnormalities has downstream consequences for breast cancer care so superior to those of open surgical biopsy that the needle biopsy rate at a medical center or in a surgeon's practice may be a useful quality-of-care benchmark, Dr. Stephen B. Edge said at a breast cancer symposium sponsored by the Cancer Therapy and Research Center.
"The use of surgical biopsy for initial evaluation of breast abnormalities should be strongly discouraged," said Dr. Edge of the Roswell Park Cancer Institute, Buffalo, N.Y.
This was the key conclusion of a National Comprehensive Cancer Network (NCCN) study he presented. The study demonstrated that breast cancers initially addressed by needle biopsy--that is, fine-needle aspiration, vacuum-assisted biopsy, or core biopsy--ultimately entailed fewer operations on the breast, fewer total trips to surgery, and less time to completion of the diagnostic and surgical phases of cancer care.
In addition, needle biopsy omits the need for surgery in most instances, since the majority of breast lesions prove benign.
The NCCN is an organization made up of 19 prominent National Cancer Institute-designated cancer centers. Dr Edge and his coworkers utilized the NCCN outcomes database to study 6,282 women who presented with stage 0-II breast cancer at one of eight NCCN centers during 1997-2002. Overall, 55% had a needle biopsy as their initial biopsy, 42% had surgical biopsy, and 3% had a onestage procedure involving definitive surgery without prior biopsy.
Of those who required further interventions, 61% of patients had breast-conserving surgery as their final operation, while 39% underwent mastectomy.
The primary study end point was the need for reexcision to complete the surgical phase of treatment, with reexcision being defined as more than one surgical operation on the breast performed on separate days. In addition to using more resources, reexcision involves greater ...
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