Diagnosing Breast Cancer: Needle Biopsy Best?
Reviewed By
Rating
Diagnosing Breast Cancer: Needle Biopsy Best?
Our Review Summary
This is a newly published systematic review of varying quality studies that were previously published — however, there is no new information here – something the story could have made clear. At leading breast centers the ‘best practice’ is to get a breast cancer diagnosis without open surgery, and usually via a core needle biopsy (CNB), but that practice has not been adopted everywhere, sometimes because of the machines (image guided bioppsy) that are needed to complete these types of biopsies are not available, or because breast surgeons are involved in care so they just remove a suspicious mass with a surgical biopsy.
Women should know that there are different types of breast biopsies following an abnormal mammogram. Core needle biospy (CNB) is less invasive and leaves less scaring that a surgical biopsy. There is also less chance of post-surgical infection with core needle v. surgical biopsy. The story here alludes to fewer complication with CNB v. surgery, dind’t explain what the side effects are.
Both methods appear to be accurate for detecting cancerous v. non-cancerous breast cells. The majority of women who are referred for breast biopsy do not have malignant lesions and do not require follow-up treatment, so the fewer surgical procedures a woman undergoes following an abnormal mammogram, the better. CNB may allow many women who are diagnosed with breast cancer to reduce the number of surgical procedures that they must undergo during treatment.
Why This Matters
The real nitty gritty information that a woman would want from such a story was missing: quality of the evidence, data on false positives and false negatives, explanation of potential harms.
Criteria
Not Satisfactory
The story does not mention the individual or general health care cost of the different types of biopsies, or if the core needle biopsy guided by x-rays or ultrasound will ultimately cost less than surgical biopsy. The story also was silent on (unaware of?) the big tug of war between surgeons (who get paid for open biopsies) and radiologists (who get paid for the stereotactic biopsies).
Not Satisfactory
The story does not compare the specificity of core needle biopsy v. surgical biopsy for accurately diagnosing breast cancer. The story does not mention that evidence from the recent analysis was for women with average risk of developing breast cancer. For women at higher risk, the accuracy may be different.
Not Satisfactory
The story mentions "complications" and "side effects" but does not discuss exactly what these include with either procedure. Surgical biospy is more invasive and risks include infection, scars and slower wound healing compared with CNB. Women who have CNB and are diagnosed with breast cancer have fewer surgeries than women diagnosed via surgical biopsy. Women at higher risk of developing breast cancer (genetic factors, prior pre-cancerous lesions or biopsies, older age) may feel more confident of their results via surgical biopsy v. CNB.
Not Satisfactory
The story provides little evidence from the source article in the Annals of Internal Medicine. The story does not provide data comparing false positives or false negatives with either procedure. The story does provide data comparing the rate of complications with each procedure. The story also does not mention the generally low quality of the studies in the meta analysis, but the focus is instead on the quanitiy of studies– 80 studies in this case– and few if any were high quality.
Satisfactory
The story does not engage in disease mongering. The story discusses recent analysis that women may be able to avoid surgical biopsies in lieu of core needle biospies for diagnosis of breast cancer. The story appropriately notes that many women who undergo a biopsy following an abnormal mammogram do not have breast cancer.
Not Satisfactory
The story has only one source who is a lead author of the study on which the story is based. It is not made explicit in the story that she is involved in the study. The story should include additional independent clinical sources to put the new information in perspective. An interview with an independent expert could help provide information on availability of various methods of CNB and their real world accuracy (e.g. are most surgeons adequately trained to perform core needle biopsies?).
Satisfactory
The focus of the story is a recent meta-analysis that adds to a body of evidence sugesting core needle biopsies are as accurate and less risky compared with surgical open biopsies for diagnosing breast cancer. Since the focus of the story was less invasive methods of biopsy, it would have been good to describe the different kinds of core needle biopsies, as well as fine needle aspiration, which is even less invasive than the core biopsy and can be used for palpable masses. Nonethless, we’ll give the story the benefit of the doubt on this criterion.
Not Satisfactory
The story does not mention if all hospitals offer women core needle biopsy as an option prior to, or instead of open surgical biopsy. We are not told if recent evidence has affected clinical guidelines for suggested biopsies following an abnormal mammogram. We are not told that some women may not be appropriate candidates for core needle biopsies. The article notes: The location and type of lesion, as well as other medical considerations, sometimes dictate the type of biopsy, but in many cases patient preference is the most important factor in the decision.
Satisfactory
Only by back-door inference (the fact that 80 studies have been done) does the reader get any sense that core needle biopsy is not new. Many treatment centers have offered this to average-risk women as an alternative to surgical biopsy for some time. The story mentions that some are hesitant to adopt it, although it is widely used and considered a "best practice" and first line biopsy option of many average risk women. We’ll give the story the benefit of the doubt on this criterion.
Not Applicable
It is difficult to tell if this story is generated directly from a news release, especially since the lead study author is the only source cited.
Total Score: 3 of 9 Satisfactory
Comments
Please note, comments are no longer published through this website. All previously made comments are still archived and available for viewing through select posts.
Our Comments Policy
But before leaving a comment, please review these notes about our policy.
You are responsible for any comments you leave on this site.
This site is primarily a forum for discussion about the quality (or lack thereof) in journalism or other media messages (advertising, marketing, public relations, medical journals, etc.) It is not intended to be a forum for definitive discussions about medicine or science.
We will delete comments that include personal attacks, unfounded allegations, unverified claims, product pitches, profanity or any from anyone who does not list a full name and a functioning email address. We will also end any thread of repetitive comments. We don”t give medical advice so we won”t respond to questions asking for it.
We don”t have sufficient staffing to contact each commenter who left such a message. If you have a question about why your comment was edited or removed, you can email us at feedback@healthnewsreview.org.
There has been a recent burst of attention to troubles with many comments left on science and science news/communication websites. Read “Online science comments: trolls, trash and treasure.”
The authors of the Retraction Watch comments policy urge commenters:
We”re also concerned about anonymous comments. We ask that all commenters leave their full name and provide an actual email address in case we feel we need to contact them. We may delete any comment left by someone who does not leave their name and a legitimate email address.
And, as noted, product pitches of any sort – pushing treatments, tests, products, procedures, physicians, medical centers, books, websites – are likely to be deleted. We don”t accept advertising on this site and are not going to give it away free.
The ability to leave comments expires after a certain period of time. So you may find that you’re unable to leave a comment on an article that is more than a few months old.
You might also like