For Physicians: Guidelines and Professional Recommendations

Breast cancer surgeons, radiologists and cancer centers have reviewed research on the best methods to detect breast cancers.  Physician organizations evaluate research findings to determine which procedures are most likely to find cancer when it is there, conclusively determine that there is no cancer when there is not, and cause the least risk of side effects to the patients.  All diagnostic tests have the possibility of error – either missing a cancer that is there or diagnosing cancer when there is none.  But, chances of error or other risk of harm are lower when doctors are experienced and specialize in breast care, and when they follow the standards of care for cancer diagnosis and treatment.

For image detected abnormalities, physician organizations recommend minimally invasive core needle biopsy as the initial biopsy approach.  There may be some exceptions in which a needle biopsy is not the first procedure, but those should be rare.  Physicians estimate that only about 5% of initial biopsies need to be carried out surgically for clinical reasons.  Currently, many surgical biopsies are carried out because the surgeon prefers to do them that way - but physician preference is not a valid clinical reason and subjects the patient to unnecessary surgery.

Clinical Guidelines
For information on recommendations of leading cancer organizations see:

• American Society of Breast Surgeons
  Statement on Percutaneous Needle Biopsy for Image Detected Breast Abnormalities
• National Comprehensive Cancer Network Clinical Practice Guidelines for Breast Cancer Screening and Diagnosis
  Version 1.2010 notes that core needle biopsy of suspicious lesions is preferred, and notes that excisional biopsy is needed in select situations when larger tissue samples are needed.
• Breast Cancer Consensus Conference
  A consensus conference of breast cancer experts published recommendations on State of the Art Diagnosis and Treatment of Breast Cancer in the Journal of the American College of Surgeons October, 2009.  These experts recommend minimally invasive breast biopsy as the optimal method of initial biopsy, noting that minimally invasive approaches can definitively establish whether the abnormality is benign and eliminate the need for a surgical procedure for most women. 
• Clinical Practice Guidelines
  For an evidence based clinical practice guideline, with decision support algorithms, see the 2010 Institute for Clinical Systems Improvement “Diagnosis of Breast Disease” guideline and others.
• Comparative Effectiveness Report
  This 2009 Comparative Effectiveness report sponsored by the federal Agency for Healthcare Research and quality includes a comprehensive assessment of various biopsy approaches examines quality and effectiveness of various options, including risks of false positive and false negative biopsies and other impacts associated with each approach. 
• American College of Radiology
  The ACR Stereotactic Breast Biopsy Accreditation Program involves the evaluation of image quality and breast dose data.

Accreditation Standards
A discussion of accreditation programs for breast care providers and facilities is on the section of this site, For PPOs – Strategies to Promote Evidence Based MIBB. According to standards of compliance developed by the National Accreditation Program for Breast Centers, image-guided needle biopsy is the initial diagnostic approach rather than open biopsy.  Further, the program establishes standards for pathology reports, stating College of American Pathologists guidelines must be followed.