ASK DR. H: Needle biopsy should be ‘gold standard’

Q: Three months ago, I had a breast biopsy that fortunately turned out to be benign (not cancer), but now I’m left with a scar that I’m not happy about. I was too scared at the time to ask questions, but now I’m wondering why the surgeon didn’t just do a needle biopsy. Can you tell me why? – S.R., Sarasota, Fla.

A: I cannot comment on your specific breast mass, but there are very few instances where an open surgical biopsy would be needed as the initial diagnostic procedure.

In fact, a panel of leading breast surgeons at the 2009 International Consensus Conference on Image Detected Breast Cancer III unanimously agreed that needle biopsy should be the “gold standard” for the initial diagnosis of breast abnormalities.

Dr. Melvin Silverstein, chairman of 2009 International Consensus Conference, commented that since only 15-20 percent of abnormalities found by mammography turn out to be cancer, a significant number of women with benign lesions are undergoing unneeded diagnostic surgery when needle biopsy done while awake using a local anesthetic is equally effective for discovering cancer.

A report published in the October 2009 issue of the Journal of the American College of Surgeons noted that 35 percent of initial breast biopsies in the U.S. are still being performed under general anesthesia using an open breast biopsy like you had. This is in spite of the fact that it’s much more invasive, requires general anesthesia and costs two to four times more than the far less invasive yet equally accurate needle biopsy.

Dr. Mitchell Hecht is a physician specializing in internal medicine. Send questions to him at: “Ask Dr. H,” P.O. Box 767787, Roswell, GA 30076. Because of the large volume of mail received, personal replies are not possible.

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