Percutaneous needle biopsy for breast diagnosis: how do surgeons decide?

Area of Science:

• Oncology
• Surgical Pathology
• Diagnostic Imaging

Background:

• Guidelines recommend core needle biopsy (CNB) for breast abnormality diagnosis.
• CNB is underutilized in certain regions despite recommendations.
• Understanding factors influencing surgeons' biopsy technique choices is crucial.

Purpose of the Study:

• To identify factors influencing surgeons' selection of breast biopsy techniques (fine-needle aspiration biopsy [FNAB], CNB, or surgical biopsy).
• To assess the impact of patient, organizational, and system factors on biopsy technique choice.
• To determine barriers to cancer care provision reported by surgeons.

Main Methods:

• A survey was administered to 385 general surgeons in Ontario.
• Surgeons evaluated six clinical scenarios with varying malignancy risk.
• Respondents rated 15 factors and described barriers to cancer care.

Main Results:

• CNB and/or FNAB were favored for high-risk lesions (83%-97%) over surgical biopsy (41%).
• CNB was preferred over FNAB for percutaneous biopsy (58%-79% vs. 1%-18%).
• Patient/clinical factors (46% FNAB, 42% CNB) and patient preference (34%, 31%) most impacted choices; delayed access to CNB was a noted issue.

Conclusions:

• Surgeon preference for CNB exceeds its current utilization.
• Further research is needed to optimize CNB use.
• Facilitating access and supporting shared decision-making may improve CNB adoption.