Preoperative Needle Biopsy Improves the Quality of Breast Cancer Surgery
“Having a preoperative diagnosis of breast cancer improved initial margin status, decreased the total number of operations, and was associated with greater use of axillary node evaluation and adjuvant radiation after breast conserving surgery,” reported lead author Ted A. James, MD, FACS, of the Department of Surgery at the University of Vermont College of Medicine in Burlington, Vermont, and coauthors.
The potential impact of PNB on patient outcomes and health care costs is “substantial,” the authors concluded.
The authors combined data from Medicare and the Vermont cancer registries to identify 1,135 women over age 65 years who had been diagnosed with breast cancer between 1998 and 2006. PNB was performed initially in 713 (62.8%) of patients; 422 (37.2%) patients underwent open surgical biopsy (OB) instead. Patient age, educational status and screening-detection were unrelated to which biopsy method was initially employed, records showed, but patients living in cities were more likely to receive PNB (70.6% PNB) than were patients in rural areas (57.5% PNB; P<0.0001). More patients were also diagnosed with PNB between 2004 and 2006 than earlier years (P<0.0001).
“Positive margins were less common in women diagnosed with PNB (20.1%) than with OB (37.4%), (P<0.0001),” the authors reported. “Close margins, defined as less than 2 mm, after initial surgery were observed in 11.9% of patients receiving PNB and 20.4% of patients undergoing OB as the initial means of diagnosis (P<0.0001).”
The mean number of surgical operations for patients in the PNB cohort was 1.26, versus 1.63 for the OB cohort (P<0.0001).
“Patients receiving PNB experienced a single surgical operation for the management of breast cancer 76.4% of the time; only 44.6% of patients undergoing OB received a single surgical operation for the management of breast cancer (P<0.0001),” the authors reported.
Adjuvant breast radiation therapy was performed after breast conserving surgery in 65.8% of PNB-cohort patients, versus 50.3% among OB-cohort patients (P<0.0001).
Lack of awareness or necessary equipment for PNB may contribute to continued use of OB, the authors suggested.