By Molly Dannenmaier | UTMB at Galveston
Roughly a third of Texas women with a breast lump end up having an old-fashioned surgical biopsy to determine whether the lump is cancerous.
Yet since 2001, the American Society of Breast Surgeons, the American College of Radiology, and the National Cancer Center Network have recommended nonsurgical, minimally invasive biopsies as the first course of action for women with breast lumps or masses. These less invasive methods of sampling breast tissue provide results that are as accurate as surgical biopsies, the organizations say.
“We need to get the word out to women across the state that surgery is not the procedure of choice for definitive diagnosis of a breast mass,” said Taylor Riall, M.D., associate professor of surgery at the University of Texas Medical Branch at Galveston.
Riall is a lead investigator of new research performed by UTMB researchers and published in the Journal of the American College of Surgeons, which reveals that despite national recommendations, invasive and expensive surgical breast biopsies were the first diagnostic step for 35 percent of Texas women diagnosed with a breast mass between 2000 and 2008. The findings were based on an exhaustive analysis of Texas Medicare data during that six-year period which gleaned information on a total of 87,000 breast biopsies.
A breast biopsy is a procedure to remove a tissue sample from a breast lump or other breast abnormality for laboratory testing. The test confirms whether the tissue is cancerous or noncancerous, which can signal whether or not patients need additional surgery.
Several types of breast biopsies are performed today, including surgical biopsies where an incision is made and all or part of the lump is removed and sent to the laboratory, and needle biopsies which are less invasive, and use a hollow needle to extract tissue samples from the lump.
The traditional, surgical method may be appropriate when a needle biopsy fails to gather enough tissue, but the surgical biopsy is too much too soon in patients with newly discovered breast masses, said Riall.
“If the woman has surgery and the mass is benign,” he said, “then the woman had surgery unnecessarily.”
Out of all the surgeries analyzed during the six-year period for the UTMB study, only 40 percent of women with breast lumps ended up having malignancies. The remaining 60 percent were noncancerous, or benign.
“Simply put, thousands of women throughout Texas underwent surgery just to find out they did not have cancer,” Riall said.
On the other hand, if a mass is found to be malignant, more surgery will probably be required to remove more tissue, so the patient will end up having multiple surgeries instead of only one,” Riall said, furthering the argument that a needle biopsy should almost always be performed first, since needle biopsies can reveal whether a breast mass is cancerous or noncancerous before any decisions about treatment are made.
“There is no benefit to the patient having an expensive, invasive surgical procedure instead of a needle biopsy,” said Riall. “At UTMB, minimally invasive biopsies are our diagnostic procedure of choice. We perform them more than 98 percent of the time.”
The National Cancer Center Network is identifying the barriers that stand in the way of reaching a 90 percent rate of minimally invasive breast biopsies nationwide. The UTMB study is a step in providing crucial information that will help in the national effort, Riall said.