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

Area of Science:

• Medical Imaging
• Surgical Pathology
• Oncology

Background:

• Lack of specific Canadian guidelines for breast biopsy techniques and imaging modalities.
• Existing international recommendations do not address the Canadian healthcare system's unique aspects.

Purpose of the Study:

• To establish consensus-based recommendations for breast biopsy techniques and imaging guidance in Canada.
• To address the gap in clinical practice guidelines for Canadian clinicians.

Main Methods:

• A modified Delphi panel of 17 Canadian experts (radiologists, pathologists, surgeons) from 6 provinces.
• Two rounds of anonymized voting with an in-person discussion, adhering to best practices for consensus development.
• Rigorous statistical analysis of 347 items, assessing agreement and disagreement.

Main Results:

• 82% (286 out of 347) of items achieved consensus.
• Recommendations cover initial biopsy technique selection based on lesion type and imaging, rebiopsy considerations, procedural details (gauge size, sample number), and patient factors.
• Consensus findings were endorsed by the Canadian Society of Breast Imaging.

Conclusions:

• The developed recommendations aim to standardize and improve breast biopsy practices nationwide.
• These guidelines provide a framework for selecting appropriate biopsy techniques and imaging modalities.
• Recommendations should be applied on a case-by-case basis, considering emerging evidence.