Minimally invasive breast biopsies underused outside cities

Rates of improvement in the use of minimally invasive breast biopsies (MIBBs) are increasing overall in Texas, but remain persistently low in the state's more rural areas, an analysis of data has revealed.

“Despite an increase over time,” MIBB use was consistently lower than recommended and varied considerably across geographic regions, reported Taylor S. Riall, MD, PhD, and fellow researchers in Journal of the American College of Surgeons (2013;216[4]:814-824).

An associate professor of surgery at The University of Texas Medical Branch (UTMB) in Galveston, Texas, Riall served as a lead investigator in the study of women aged 66 years and older who underwent breast biopsy. The women were identified through Texas Medicare claims data (2000–2008); biopsies were classified as open (surgical) or as MIBB (performed under ultrasonographic or x-ray guidance with either a fine needle or a core tissue extraction needle).

As the authors noted, current guidelines recommend MIBB as the gold standard for the diagnosis of breast lesions. However, the evaluation showed that open procedures remained the first diagnostic step in 35% of the 87,165 biopsies performed on 75,518 breast masses in 67,582 women. Surgeons performed 94.2% of the open biopsies and 26.2% of the MIBBs. Radiologists performed 70.3% of the MIBBs.

Women undergoing MIBB were more likely to live in metropolitan areas and to have higher income and educational levels. Black women and white women were more likely to undergo MIBB than were Hispanic women, at 68.9%, 66.6%, and 55.9%, respectively.

Although the rate of MIBB increased from 44.4% in 2001 to 79.1% in 2008, clear geographic patterns were seen in MIBB use, with the highest use near major cities. “There is no benefit to the patient in having an expensive, invasive surgical procedure instead of a needle biopsy,” contended Riall in a statement issued by UTMB. “We need to get the word out to women across the state that surgery is not the procedure of choice for definitive diagnosis of breast mass.”

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