Core needle biopsy procedures may be reasonable alternative to surgical biopsy for breast cancer

Stereotactic- and ultrasound-guided core needle biopsy procedures were almost as accurate as surgical biopsy in women of average-risk suspected of having breast cancer; however, the core needle biopsies yielded lower complication rates.

Researchers examined the harms and benefits of these two biopsy procedures by examining clinical data gathered from trials taken from databases including Medline and Embase between 1990 and 2009. The strength of evidence supporting the conclusions was graded as high, moderate, low or insufficient.

The researchers analyzed data from 33 studies of 7,153 biopsies using stereotactic guidance and automated biopsy gun; 22 studies of 7,512 biopsies using stereotactic guidance and a vacuum-assisted device; seven studies of 507 biopsies using ultrasound guidance and a vacuum-assisted device; and five studies of 610 biopsies that reported data on the accuracy of nonguided core needle biopsies performed with automated biopsy gun devices.

Although the strength of evidence was rated as low, researchers determined that “core-needle biopsies conducted under stereotactic guidance with vacuum assistance distinguished between malignant and benign lesions with an accuracy similar to that of open surgical biopsy.”

Following core needle biopsy, severe complications were rare, affecting less than 1% of procedures. There was a slight association between vacuum-assisted procedures and more bleeding events than automated gun core needle biopsies. Evidence supporting these findings was rated as low by the researchers.

Data from 31 studies demonstrated that women diagnosed with breast cancer by core needle biopsy were typically able to have treatment with a single surgical procedure whereas women diagnosed by open surgical procedure usually required more than one surgical procedure (OR=13.7; 95% CI, 5.6-34.6). The strength of this evidence was rated as moderate.

“When making decisions about what type of biopsy to use, individual women and their health care providers will need to weigh the pros and cons of each type of biopsy,” the researchers said.