Consensus panel calls for expanded role of needle biopsies, MRI and less invasive procedures

October 06, 2005

LOS ANGELES, Oct. 6 - Physicians should strive to replace traditional, invasive procedures for diagnosing breast cancer with proven, less-invasive diagnostic methods, according to an international panel of breast cancer experts convened at the Keck School of Medicine of the University of Southern California.

In a consensus paper published in October's Journal of the American College of Surgeons (JACS), 23 leading surgeons, radiologists, pathologists and oncologists say minimally invasive needle breast biopsies and sentinel node biopsies should be performed more routinely than they currently are. In the case of breast biopsies, the experts say open surgical biopsies should almost never be done, though experts estimate that nearly a third of the 1.7 million breast biopsies performed in the nation are still done this way.

ÒNew technology has changed the face of breast cancer," said consensus panel chair Melvin J. Silverstein, M.D., professor of surgery and Henrietta C. Lee Chair in Breast Cancer Research at the Keck School of Medicine. "We can do things much less invasively than ever before, and doctors and women need to take advantage of these advances whenever they can."

The American Cancer Society estimates that 211,240 women will be diagnosed with invasive breast cancer and more than 40,000 will die from the disease this year.

The panel concluded that minimally invasive needle breast biopsy is "the procedure of choice for image-detected breast abnormalities" and keeps the majority of women with non-cancerous findings out of the operating room. For those who do have breast cancer, needle biopsies allow for better pre-operative planning for breast surgery.

A needle biopsy is performed through an incision about the size of a match head, requires no stitches and can be done in a doctor's office. According to the American Cancer Society, about eight of every 10 breast biopsies performed turn out to be benign.

The panel added that vacuum-assisted needle biopsies are preferred for microcalcifications, a common breast finding, because of the biopsies' high accuracy and more complete tissue removal than conventional needle biopsies.

The panel also said minimally invasive needle breast biopsies can result in significant cost savings.

"The way breast cancer is diagnosed often affects the way it is treated," said Silverstein, chief of the breast service at LAC+USC Medical Center and director of the Harold E. and Henrietta C. Lee Breast Center at USC/Norris Comprehensive Cancer Center. "If a surgeon knows the abnormality is breast cancer before an operation, he or she can more precisely plan the optimal location of the incisions in the breast for breast conservation. With pre-operative planning, more complete and precise removal of the cancer is more likely, generally sparing patients a second surgery. A biopsy is for diagnosis, surgery is for treatment."

The panel called the less invasive sentinel lymph node biopsy the "preferred method" for accurately staging image-detected breast cancer in most patients. The traditional procedure is axillary node dissection, the removal of nearly 15 to 30 lymph nodes. In sentinel lymph node biopsy one to three lymph nodes are removed resulting in fewer complications, faster recovery and a lower probability of lymphedema, a painful swelling of the arm.

The panel also looked at the emerging role of magnetic resonance imaging, or MRI, in diagnosing breast cancer. The panel concluded that evidence supports MRI's use in diagnosing disease among young patients at high risk for breast cancer and that it can be helpful for diagnosis when mammography, ultrasound and clinical findings are inconclusive.

In the area of radiation therapy, the panel concluded that accelerated partial breast irradiation (APBI) "may allow more patients to undergo breast conserving therapy more quickly, at lower cost, and with less risk of long-term complications." Traditionally, radiation oncologists treat the entire breast, which can result in breast shrinkage, as well as side effects on the heart and lungs. Until definitive data are collected, though, the panel recommended restricting APBI use only to clinical trials.

Finally, the panel recommended that surgeons train in oncoplastic surgery, the combination of plastic surgery and cancer surgery, to help avoid poor cosmetic results and increase the number of women who can be treated with breast-conserving surgery rather than mastectomy.

"We hope this consensus encourages doctors to review the methods they currently use and helps women become more aware of their options," Silverstein said.
-end-
The consensus paper "Image-Detected Breast Cancer: State-of-the-Art Diagnosis and Treatment," was developed from a conference sponsored by USC/Norris Comprehensive Cancer Center and the Keck School earlier this year and was supported by an educational grant from Ethicon Endo-Surgery Inc., a Johnson & Johnson company. It updates a JACS consensus article published September 2001.

All conference participants co-authored the JACS consensus paper.

University of Southern California

Related Breast Cancer Articles from Brightsurf:

Oncotarget: IGF2 expression in breast cancer tumors and in breast cancer cells
The Oncotarget authors propose that methylation of DVDMR represents a novel epigenetic biomarker that determines the levels of IGF2 protein expression in breast cancer.

Breast cancer: AI predicts which pre-malignant breast lesions will progress to advanced cancer
New research at Case Western Reserve University in Cleveland, Ohio, could help better determine which patients diagnosed with the pre-malignant breast cancer commonly as stage 0 are likely to progress to invasive breast cancer and therefore might benefit from additional therapy over and above surgery alone.

Partial breast irradiation effective treatment option for low-risk breast cancer
Partial breast irradiation produces similar long-term survival rates and risk for recurrence compared with whole breast irradiation for many women with low-risk, early stage breast cancer, according to new clinical data from a national clinical trial involving researchers from The Ohio State University Comprehensive Cancer Center - Arthur G.

Breast screening linked to 60 per cent lower risk of breast cancer death in first 10 years
Women who take part in breast screening have a significantly greater benefit from treatments than those who are not screened, according to a study of more than 50,000 women.

More clues revealed in link between normal breast changes and invasive breast cancer
A research team, led by investigators from Georgetown Lombardi Comprehensive Cancer Center, details how a natural and dramatic process -- changes in mammary glands to accommodate breastfeeding -- uses a molecular process believed to contribute to survival of pre-malignant breast cells.

Breast tissue tumor suppressor PTEN: A potential Achilles heel for breast cancer cells
A highly collaborative team of researchers at the Medical University of South Carolina and Ohio State University report in Nature Communications that they have identified a novel pathway for connective tissue PTEN in breast cancer cell response to radiotherapy.

Computers equal radiologists in assessing breast density and associated breast cancer risk
Automated breast-density evaluation was just as accurate in predicting women's risk of breast cancer, found and not found by mammography, as subjective evaluation done by radiologists, in a study led by researchers at UC San Francisco and Mayo Clinic.

Blood test can effectively rule out breast cancer, regardless of breast density
A new study published in PLOS ONE demonstrates that Videssa® Breast, a multi-protein biomarker blood test for breast cancer, is unaffected by breast density and can reliably rule out breast cancer in women with both dense and non-dense breast tissue.

Study shows influence of surgeons on likelihood of removal of healthy breast after breast cancer dia
Attending surgeons can have a strong influence on whether a patient undergoes contralateral prophylactic mastectomy after a diagnosis of breast cancer, according to a study published by JAMA Surgery.

Young breast cancer patients undergoing breast conserving surgery see improved prognosis
A new analysis indicates that breast cancer prognoses have improved over time in young women treated with breast conserving surgery.

Read More: Breast Cancer News and Breast Cancer Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.