"It's really an issue of appropriate management," says Dr. Berg, "and core biopsy allows appropriate triaging of patients to have surgery who need it and to avoid it for the vast majority of benign conditions."

Faster, cheaper and probably safer


Although open surgical biopsies are generally quite safe, they do present a risk for infection. About 38 to 63 out of 1,000 open surgical biopsies lead to infections, according to the study's estimates, whereas they are exceedingly rare for core-needle ones.

"Infection is extremely unlikely, we're talking one in 1,000, if that," says Dr. Berg.

Hematomas, the pooling of blood outside of blood vessels, are also much more common in open surgical biopsies, although they're not unknown in core-needle biopsies.

"It's more common when we use the larger, vacuum-assisted biopsies," says Dr. Berg. "With a 14-gauge core-needle, automated gun, which is what I usually use for ultrasound-guided biopsies, the hematoma rate is extremely low."

Core-needle biopsies, are less invasive, cost less, and according to Dr. Berg, can be done in around 15 minutes; whereas surgical biopsies, like all surgical procedures, are longer, more expensive and involved processes.

"Pretty much the woman has lost the day for the surgical procedure. Then they have a certain amount of recovery, typically about a week," says Dr. Berg. "With core-needle biopsy, you can go back to your routine that day."

Women undergoing core-needle biopsies, over the long run, also end up getting fewer surgeries, says Dr. Berg. This is because a finding of cancer in core-needle biopsy could lead to immediate treatment with chemotherapy, and it also allows the patient and surgeon to plan treatment surgery to remove enough tissue to have clear margins around the cancer and to sample the lymph nodes, if necessary. This makes it less likely the women will undergo a second surgery.

But women getting open surgical biopsies for initial diagnosis often won't have their lymph nodes sampled or excised in that procedure, as most surgeons are unwilling to expose women to the risks of lymph node sampling, such as lymphedema, unless they're sure they're dealing with cancer. More important, the cancer is much less likely to be completely removed in a diagnostic surgical biopsy, so the patient will usually need at least one more surgery for treatment.




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