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Percutaneous Needle Biopsy for Breast Diagnosis: How Do Surgeons Decide?

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Despite the advent of guidelines recommending core needle biopsy (CNB) for diagnosis of breast abnormalities, it is underused in some jurisdictions. We sought to determine those factors influencing surgeons’ choices of breast biopsy techniques.

Methods

We surveyed 385 general surgeons in Ontario to first determine factors influencing the choice of fine-needle aspiration biopsy (FNAB), CNB, both or neither for diagnosis of breast abnormalities in six clinical scenarios with varying risk of malignancy. Second, respondents were asked to rate 15 patient, organizational, and system factors for their impact on choice of biopsy technique. Third, surgeons were asked to describe their three greatest barriers to provision of cancer care.

Results

Response rate was 44%, and 126 provided answers to the survey questions. When there was a high risk of malignancy, CNB and/or FNAB were favored over surgical biopsy (83% to 97% compared with 41% for presumed benign lesions), and CNB was preferred for percutaneous biopsy over FNAB (58% to 79% compared with 1% to 18%). Patient and clinical factors (46% FNAB, 42% CNB), patient preference for biopsy technique (34%, 31%), and delayed access to CNB, rather than lack of equipment (11% FNAB, 8% CNB) or expertise for CNB or FNAB (15%, 12%), had the greatest reported impact on choice of biopsy technique.

Conclusions

Surgeon preference for CNB is higher than actual use. Further research is needed to establish whether or how CNB use could be improved by support for shared decision making or facilitating access.

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Acknowledgment

This study was conducted and published with funding from the University of Toronto, Faculty of Medicine Dean’s Fund New Staff Grant, and an unrestricted research grant from Cancer Care Ontario. Neither source had any influence on the collection, analysis, and interpretation of data, on the writing of the manuscript, or in the decision to submit the manuscript for publication.

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Authors and Affiliations

  1. Department of Surgery, Sunnybrook Health Sciences Centre and the University of Toronto, Toronto, ON, Canada

    Claire M. B. Holloway MD, PhD & Anna R. Gagliardi PhD

Authors
  1. Claire M. B. Holloway MD, PhD
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  2. Anna R. Gagliardi PhD
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Corresponding author

Correspondence to Claire M. B. Holloway MD, PhD.

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Holloway, C.M.B., Gagliardi, A.R. Percutaneous Needle Biopsy for Breast Diagnosis: How Do Surgeons Decide?. Ann Surg Oncol 16, 1629–1636 (2009). https://doi.org/10.1245/s10434-009-0451-3

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  • DOI: https://doi.org/10.1245/s10434-009-0451-3

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