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Single-Port Robotic-assisted Transaxillary Breast-conserving Surgery: A Prospective, Single-arm, Non-randomized Phase IIa Clinical Trial
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Preoperative prediction of open breast biopsy results
1Department of Surgery, St. Barnabas Medical Center, Livingston, New Jersey, USA.
Background:
The accuracy of a surgeon's clinical judgment dictates the need for interventional diagnostic procedures to identify breast carcinoma patients. Few studies exist in which such accuracy is determined.
Methods:
A series of 2247 consecutive open breast biopsies in newly presenting patients is presented in which the author preoperatively predicted a benign or malignant condition.
Results:
Positive predictive values for all patients, patients with breast lumps, and patients with abnormal mammograms were 0.49, 0.68, and 0.39, respectively, with the highest positive predictive value (0.89) found in women 50 years or older with a breast lump. Negative predictive values for all patients, patients with a breast lump, and patients with abnormal mammograms were 0.94, 0.94, and 0.93, respectively, with the highest values found in women younger than 30 years (0.98) and in women younger than 50 years (0.95).
Conclusions:
Negative predictive values are reliable enough in women younger than 50 years to justify initial clinical observation of many benign appearing breast conditions. Minimal interventional procedures and open breast biopsies have a tendency to be overutilized in an effort to avoid any delay in the diagnosis of breast carcinoma. Fear of failure to diagnose breast carcinoma in a "timely fashion" is a driving force for interventional procedures in many situations in which close clinical follow-up alone is justifiable.
