UCSF Experience Runs Counter to Findings from Study of Breast Biopsies

The following is a guest post by Belinda Chang, M.D., Assistant Professor of Clinical Radiology.

A recent Florida study, as reported in The New York Times, concluded that three times the number of surgical breast biopsies are being performed than medical guidelines call for.

The authors of that study are of the opinion that three times the number of women are having unnecessary surgery, and the associated costs are in the hundreds of millions of dollars a year.

That may be the experience in Florida, where the research was performed, but the common practice at UCSF is dramatically different.

At our institution, the culture calls for performing percutaneous core biopsy over open surgical biopsy whenever possible. Surgeons, pathologists and oncologists agree that there are several advantages to completing a percutaneous core biopsy ahead of an open surgical biopsy.

A needle biopsy is safer, less invasive and more economical. It requires only numbing with a local anesthetic, whereas open surgical biopsy subjects the patient to the risks associated with the required general anesthesia as well as the risks of infection and scarring. In addition, when performed properly, percutaneous core biopsies have been shown to be equally effective as surgical excisional biopsies. What is learned about the pathology of the tumor after performing percutaneous biopsy is generally in line with what can be learned from an open surgical biopsy.

Percutaneous core biopsy offers additional advantages in treatment planning. Performing a percutaneous core biopsy will often obviate the need for surgery if the pathology is benign. When the pathology is malignant, oncologists and surgeons can obtain additional information from the biopsy sample, including hormone receptors that provide valuable prognostic information. The oncologist may tailor neoadjuvant chemotherapy to a patient’s particular tumor pathology prior to surgery. Furthermore, the surgeon can offer a more appropriate surgical treatment plan such as a wider surgical margin and axillary lymph node dissection.

Of course there are times when needle biopsy is not feasible, such as when the location of the tumor would make it unsafe to perform percutaneous core biopsy. In such instances, open surgical biopsy is the practical alternative.