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Health Answers

Core needle biopsy vs. open biopsy

By Judy Foreman
March 9, 2009
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Q. Should a suspicious mammogram prompt an "open" biopsy?

A. No, not usually.

The first step in determining the reason for a troubling mammogram should be a minimally invasive "core needle" biopsy, according to guidelines issued in 2005 by the American College of Surgeons Consensus Conference and a 2006 statement by the American Society of Breast Surgeons.

In this procedure, the woman is given a local anesthetic and a small amount of tissue is extracted through a needle, often under ultrasound or MRI guidance, for analysis. Needle biopsies cost about $1,000, are very accurate, and allow a woman to return to work within a day.

But in 40 percent of cases, surgeons do "open" or "excisional" biopsies, according to Columbia University research published recently in the Journal of the American College of Surgeons. These procedures cost $5,000, plus anesthesia fees.

Open biopsies are no more accurate, and they often leave women with scars that can impede a subsequent operation if she turns out to have cancer. These more invasive biopsies can also lead to infection or bruising.

By either method, biopsies show that 80 percent of the time, women with suspicious mammograms turn out not to have cancer.

"Needle biopsy is the preferred method of diagnosis. Needle biopsy should happen 98 percent of the time," says Dr. Melvin Silverstein, director of the breast program at Hoag Memorial Hospital Presbyterian in Newport Beach, Calif., who wrote an editorial accompanying the recent research.

It is "outrageous and ridiculous" that so many women are still getting open biopsies, he said, adding, "Once women know this, they will not tolerate it."

To be sure, there are times when a woman does need an open biopsy, such as when the breast is very small, when the suspicious area is close to the skin or the chest wall, when she has breast implants or is extremely "needle phobic."

But overall, says Dr. Michelle Specht, a breast surgeon at Massachusetts General Hospital, "the more that women push for core biopsies, the better."

E-mail health questions to foreman@globe.com.

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