Canadian Recommendations on Optimal Breast Biopsy Practices Developed Using a Modified Delphi Panel

There are few recommendations in Canada to assist clinicians in selecting appropriate biopsy techniques (fine-needle aspiration, core-needle biopsy, vacuum-assisted biopsy, vacuum-assisted excision) and imaging technologies (mammography, ultrasound, magnetic resonance imaging, contrast-enhanced mammography) for biopsy guidance. Limited existing recommendations from other countries do not consider the unique aspects of the Canadian healthcare system. To address this gap, 17 experts participated in a modified Delphi panel to reach consensus on biopsy-related topics and provide recommendations. The panel was comprised of 12 radiologists, 2 pathologists, and 3 surgeons from 6 provinces across Canada. Panelists engaged in two rounds of anonymized voting, with an in-person discussion held between the rounds. The modified Delphi panel adhered to best practices, including establishing consensus definitions prior to voting, utilizing anonymized voting, and abstaining from communication among panelists before the in-person meeting. A rigorous statistical approach was utilized to analyze the points of agreement and disagreement. Consensus findings covered a wide range of topics, including recommendations for initial biopsy technique based on lesion type and imaging modality, patient management or rebiopsy considerations after the initial biopsy, procedural recommendations (i.e., gauge size, number of samples), patient considerations (i.e., drug allergies, pregnancy). Overall, 347 individual items were included in the final analysis, 286 (82%) of which achieved consensus. These consensus recommendations intend to offer general recommendations to help standardize and improve practices across Canada and were endorsed by the Canadian Society of Breast Imaging. However, they should be evaluated in the context of each individual case and emerging evidence.