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.