SAN ANTONIO--Unresolved questions about accuracy and cost should
limit the role of stereotactic core biopsy in breast cancer to
low-suspicion lesions and a few other specific indications, advised
Monica Morrow, MD, associate professor of surgery and director
of clinical breast programs, Northwestern University Medical School.
Recent assertions that stereotactic core biopsy has supplanted
surgical excision appear to be premature, based on close inspection
of available data about the purported accuracy of the technique,
its ability to characterize malignant lesions, and its cost vis-a-vis
surgical excision, Dr. Morrow said at the closing plenary session
of the San Antonio Breast Cancer Symposium.
Moreover, she claims, the increase in use of core biopsy in the
past several years has occurred in the absence of clinical standards
and credentialing procedures. "The ability to buy one of
the machines does not necessarily mean that one knows how to use
it," she said.
Still other concerns surround the role of the radiologist as the
primary care physician. Responsibility for communicating with
patients, counseling on treatment, and ensuring mammographic follow-up
remain unresolved, she said.
With those caveats, Dr. Morrow believes that stereotactic core
biopsy is an important diagnostic technique whose usefulness still
lies mostly in the future.
In the November, 1994, issue of Radiology, a report on 20 institutions'
experience with core biopsy revealed a 0.2% miss rate for breast
malignancies. On that basis, the authors concluded that core biopsy
is ready to replace surgical excision as the method of choice
for evaluating breast lesions.