Navigation Links
Needle biopsy underused in breast cancer diagnosis, negatively impacting diagnosis and care

Needle biopsy, the standard of care radiological procedure for diagnosing breast cancer, is underused with too many patients undergoing the more invasive, excisional biopsy to detect their disease, according to research from The University of Texas MD Anderson Cancer Center.

The study, published in the Journal of Clinical Oncology, also finds that patients are often influenced by surgeons to undergo the unnecessary surgery -- a decision that's costly and can negatively impact their diagnosis and treatment.

A needle biopsy is a non-surgical procedure typically performed by a radiologist that uses a thin needle to remove sample tissue from the breast. The procedure was originally endorsed as a reasonable standard of care in 1997 by a Joint Task Force comprising the American College of Surgeons (ACS), College of American Pathologists and American College of Radiologists.

The procedure was endorsed as a quality measure by the ACS in 2006, says Benjamin Smith, MD, associate professor in MD Anderson's departments of Radiation Oncology and Health Services Research.

"Still too often in my practice, I see patients that come to MD Anderson for care after having an excisional biopsy performed for diagnosis, when they obviously could have had a needle biopsy," says Smith, the study's corresponding author. "Often, the excisional biopsy negatively affects other aspects of breast cancer treatment and is simply a wasteful procedure. With this study, we wanted to quantitate the magnitude of that waste on a national scale, and identify some of the impacts of that practice pattern on the well-being of patients."

For the retrospective study, Smith and his colleagues reviewed Medicare claims of 89,712 patients diagnosed with breast cancer from 2003-2007. All were treated with breast conserving surgery and radiation. The study also identified 11,279 diagnosing surgeons and 12,405 treating surgeons. Of the patients, 68.4 percent (61,353) underwent a needle biopsy, with the rate of those undergoing the procedure increasing from 60.8 percent in 2003 to 76.5 percent in 2007.

Of the total cohort, 68.4 percent of the patients consulted with a surgeon prior to a biopsy and 31.6 percent saw a surgeon after their biopsy. Of the patients who saw a surgeon upfront: 46.3 percent did not have a needle biopsy; 38.4 percent underwent the procedure, but performed by their surgeon; and 15.4 percent had the needle biopsy performed by a radiologist. In contrast, all patients who saw a surgeon post-biopsy underwent the needle biopsy.

The researchers found that surgeon characteristics associated with excisional biopsy included: lack of board certification; training outside the U.S.; medical school graduation before 1980 and low case volume. Also, patient characteristics most associated with surgeon consultation before biopsy, and thus a lower rate of needle biopsy, were: older age; black race; Medicaid coverage; co-morbid illness; earlier year of diagnosis and rural residence.

Geographical discrepancies in the rate of needle biopsies performed were noted -- the researchers contrast the low rate of 24.1 percent in Bismarck, North Dakota to a high of 97.2 percent in Lynchburg, Virginia. Yet, Smith notes that access issues were far less of a factor for the decision than that of the surgeon's influence.

"The real question is the role of the surgeon and to understand that influence. With our study, we set up a statistical model that allowed us to compare the impact of patient-to-surgeon factors. While there are access issues that should be addressed, it's clear that the surgeon's role is very important for the patients' care," explains Smith.

Excisional biopsies were negatively associated with multiple breast cancer surgeries, 69.6 percent, compared to 33.7 percent of those who did not undergo the surgery.

For patients, says Smith, it's important to know that needle biopsy is considered the standard of care for breast cancer diagnosis, it's relatively readily accessible, and there are possible medical benefits of making the right decision -- such as preventing additional surgeries and enduring fewer complications.

"An open surgical biopsy actually makes lymph node biopsy less accurate -- and lymph node status is the most important factor when making critical decisions about adjuvant therapy. So breast cancer patients should be fully educated that this is the standard of care and ask for it," stressed Smith.

"For physicians, I think our findings suggest an opportunity to educate and encourage them to do the right thing in the best interest of their patient," Smith continued.


Contact: Laura Sussman
University of Texas M. D. Anderson Cancer Center

Related medicine news :

1. Wimbledon Health Partners Expands Services to Include Needle EMG in New York
2. Fill Lines and Wrinkles Without Needles: The New Ageless Line Smoother from Sublime Beauty® Includes Patented Hyacare® Filler CL, Argireline® and Matrixyl®
3. Pain-free microneedle influenza vaccine is effective, long-lasting
4. New York Plastic Surgeon Offers New Microcannula Technique Injectable Treatments; Dr. Ran Y. Rubinstein Announces Addition of DermaSculpt as an Alternative to Needles
5. Drug Delivery Technology Pharmaceutical Market (Metered Dose Inhalers, Needle-Free Injectors) is Worth $224.2 Billion by 2017 - New Report by MarketsandMarkets
6. InventHelp® Introduces a Device for Safe Needle Disposal Invented by a Physician (FED-1210)
7. Spectrum Surgical Offers Veterinary Gold-Handled Needle Holder Repair & Refurbishing Services
8. Corporate Whistle Blower Center Urges ER Doctors Or Hospital Staff To Turn In Hospitals That Are Needlessly Admitting Patients-For Huge Whistleblower Rewards
9. Nano Medicine Might Someday Free Diabetics From Daily Needles
10. Oral drops can give kids needle-free relief from asthma, allergies
11. Get Rid of Varicose Veins in Time for Summer with Shaft Medical San Diego’s Micro Needle Sclerotherapy
Post Your Comments:
Related Image:
Needle biopsy underused in breast cancer diagnosis, negatively impacting diagnosis and care
(Date:11/27/2015)... ... 2015 , ... There is only one major question facing all law firms ... This question has not been an easy question to answer. Especially when the senior ... younger workforce don’t share the same discipline around working long hours. , In ...
(Date:11/27/2015)... ... , ... A team of Swiss doctors has released a report on mesothelioma ... posted the findings on the website. Click here to read the details now. ... patients who were treated with chemotherapy followed by EPP surgery. Among the 106 patients ...
(Date:11/27/2015)... ... November 27, 2015 , ... ProSidebar: Fashion is ... Pro X. With ProSidebar: Fasion, video editors can easily add an informative sidebar ... minimalist title opener. Utilize presets featuring self-animating drop zones, lines, bars, and text ...
(Date:11/27/2015)... ... 27, 2015 , ... The moment you stop improving is ... fulfilling the needs of advisers and clients but going above and beyond to ... customer service. However, there's always room for improvement, which is why the entire ...
(Date:11/27/2015)... ... 2015 , ... Avid collector, Andrew Hawley from Vintage Rock Posters, announces his ... is one of Joplin's most famous and beautiful concert posters. The concert was held ... Ann Arbor. The According to Hawley, "It is hard to believe that Joplin's stardom ...
Breaking Medicine News(10 mins):
(Date:11/26/2015)... 26, 2015 ... of the  "2016 Future Horizons and ... Surface Marker Testing Market: Supplier Shares, ... their offering.  --> ... the  "2016 Future Horizons and Growth ...
(Date:11/25/2015)... 25, 2015  The American Academy of Pediatrics ... and the March of Dimes cheered today,s signature ... Infants Act of 2015 (S.799), which takes ... born exposed to drugs, such as opioids, and ... all three organizations have worked together leading advocacy ...
(Date:11/25/2015)...  ARKRAY USA , Inc., a ... demonstrating the accuracy of its blood glucose meter systems. ... Diabetes and Cardiovascular Disease in Los Angeles ... ® 01 meter and the Assure ® ... to accurately measure glucose levels in blood is essential ...
Breaking Medicine Technology: