title: Systematic review: comparative effectiveness of core-needle and open surgical biopsy to diagnose breast lesions.
abstract: BACKGROUND
  Most women undergoing breast biopsy are found not to have cancer.
  
  
  OBJECTIVE
  To compare the accuracy and harms of different breast biopsy methods in average-risk women suspected of having breast cancer.
  
  
  METHODS
  Databases, including MEDLINE and EMBASE, searched from 1990 to September 2009.
  
  
  METHODS
  Studies that compared core-needle biopsy diagnoses with open surgical diagnoses or clinical follow-up.
  
  
  METHODS
  Data were abstracted by 1 of 3 researchers and verified by the primary investigator.
  
  
  RESULTS
  33 studies of stereotactic automated gun biopsy; 22 studies of stereotactic-guided, vacuum-assisted biopsy; 16 studies of ultrasonography-guided, automated gun biopsy; 7 studies of ultrasonography-guided, vacuum-assisted biopsy; and 5 studies of freehand automated gun biopsy met the inclusion criteria. Low-strength evidence showed that core-needle biopsies conducted under stereotactic guidance with vacuum assistance distinguished between malignant and benign lesions with an accuracy similar to that of open surgical biopsy. Ultrasonography-guided biopsies were also very accurate. The risk for severe complications is lower with core-needle biopsy than with open surgical procedures (<1% vs. 2% to 10%). Moderate-strength evidence showed that women in whom breast cancer was initially diagnosed by core-needle biopsy were more likely than women with cancer initially diagnosed by open surgical biopsy to be treated with a single surgical procedure (random-effects odds ratio, 13.7 [95% CI, 5.5 to 34.6]).
  
  
  CONCLUSIONS
  The strength of evidence was rated low for accuracy outcomes because the studies did not report important details required to assess the risk for bias.
  
  
  CONCLUSIONS
  Stereotactic- and ultrasonography-guided core-needle biopsy procedures seem to be almost as accurate as open surgical biopsy, with lower complication rates.
  
  
  BACKGROUND
  Agency for Healthcare Research and Quality.
authors.affiliation: ECRI Institute, 5200 Butler Pike, Plymouth Meeting, PA 19462-1298, USA.
authors.forename: Wendy
authors.initials: W
authors.lastname: Bruening
authors.forename: Joann
authors.initials: J
authors.lastname: Fontanarosa
authors.forename: Kelley
authors.initials: K
authors.lastname: Tipton
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Treadwell
authors.forename: Jason
authors.initials: J
authors.lastname: Launders
authors.forename: Karen
authors.initials: K
authors.lastname: Schoelles
mesh_terms: D001706:Biopsy / Q000009:adverse effects / Q000379:methods*; D001707:Biopsy, Needle / Q000009:adverse effects / Q000379:methods*; D001940:Breast / Q000473:pathology* / Q000601:surgery; D001943:Breast Neoplasms / Q000473:pathology*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D012306:Risk; D012680:Sensitivity and Specificity; D013238:Stereotaxic Techniques; D016217:Ultrasonography, Mammary; D014618:Vacuum