Authors' objectives:

This report examines the quality of the scientific evidence underpinning the vacuum-assisted breast biopsy (VAB) and the advisability of offering this procedure to patients requiring a breast biopsy after detection of a non-palpable mammographic abnormality. This technical note also examines the economic aspects and the quality-assurance measures required to guarantee that core needle biopsies yield maximum benefits while avoiding errors and complications.

Authors' recommendations: Given the lack of high-quality studies offering a direct comparison of conventional and vacuum-assisted core needle biopsies, the conclusions proposed here should be interpreted with caution. 1) Vacuum-assisted breast biopsy (VAB) should not replace conventional core needle biopsy (CNB) for all biopsies of non-palpable breast abnormalities. Vacuum-assisted breast biopsy is more of an evolutionary than a revolutionary practice. The diagnostic performance of the VAB is comparable to that of the CNB, and the case series published in the literature suggest that the limited clinical gains that can be attributed to the VAB do not justify its major additional costs. 2) In spite of this general observation, some clinical indications may justify the use of vacuum-assisted breast biopsy. In such cases, the VAB may offer the advantage of avoiding open surgery. However, it is not very logical to believe that this would reduce the bottlenecks in surgical departments. It would be important to identify the clinical indications for which the use and higher cost of the VAB may be justified. In Quebec, the mandate to develop a protocol defining these indications should be entrusted to an expert committee working in collaboration with the mammography committee of the Association des radiologistes du Quebec and with the College des medecins du Quebec. 3) Whether vacuum-assisted or not, core needle biopsy offers a safe alternative to surgical biopsy, provided that high levels of expertise are achieved. In particular, detection of the discordance between benign histological findings and suspicious mammographic findings should help correct the diagnosis for most missed cancer cases, but doing so requires expertise and multidisciplinary collaboration. All core needle biopsies of non-palpable breast abnormalities should therefore be performed only in centres that have achieved a high level of expertise in diagnosing breast abnormalities and that have multidisciplinary teams collaborating closely to assess the cases. These teams should have a formal procedure for evaluating the diagnostic performance of core needle biopsy techniques by measuring statistical parameters such as their positive predictive value in order to avoid an excessive number of invasive diagnostic examinations. These teams should also undertake to reserve the VAB for clinical indications for which it offers clear advantages over conventional biopsy techniques. Referring patients to specialized clinics would entail the need to re-evaluate the relevance of continuing to have such a large number of centres providing core needle biopsies in Quebec. It would also offer the advantage of curtailing costs arising from the unnecessary duplication of technical infrastructures, while reserving the more costly techniques to women who would most benefit from them.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.aetmis.gouv.qc.ca/

Year Published: 2006

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Agence d'évaluation des technologies et des modes d'intervention en santé

Contact Address: 2021, avenue Union, Bureau 10.083,Montreal, Quebec H3A S29, Canada.Tel: +1 514 873 2563; Fax: +1 514 873 1369

Contact Name: demande@inesss.qc.ca

Contact Email: demande@inesss.qc.ca

Copyright: Agence d'Evaluation des Technologies et des Modes d'Intervention en Sante (AETMIS)