Breast biopsy: core-needle or open surgical?

Should the need arise to definitively determine the nature of a breast lesion by biopsy, there is a choice to face: extracting a small amount of tissue by needle (core-needle biopsy) or a procedure that removes the tissue specimen through an incision (open surgical biopsy). In the absence of clear evidence this decision has added to the anxiety of the situation. The authors of a paper just published in the Annals of Internal Medicine set out...

"To compare the accuracy and harms of different breast biopsy methods in average-risk women suspected of having breast cancer...Studies that compared core-needle biopsy diagnoses with open surgical diagnoses or clinical follow-up."

What did their data show?

"Low-strength evidence showed 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. Ultrasonography-guided biopsies were also very accurate. The risk for severe complications is lower with core-needle biopsy than with open surgical procedures."

Bear in mind that there is a legitimate concern about the potential for the spread of malignant cells when an tumor is invaded. Their conclusion is worth noting:

"Stereotactic- and ultrasonography-guided core-needle biopsy procedures seem to be almost as accurate as open surgical biopsy, with lower complication rates."