title: Are percutaneous biopsy rates a reasonable quality measure in breast cancer management?
abstract: BACKGROUND
  Utilization of percutaneous needle biopsy (PNB) has been proposed as a quality measure of breast cancer care. We evaluated rates and reasons for failure of patients undergoing PNB as the initial diagnostic procedure for evaluation of breast pathology.
  
  
  METHODS
  We performed a retrospective review of sequential patients undergoing image-guided PNB and open surgical excisional breast biopsies from January 2006 to July 2009 at our institution. Factors associated with failure to undergo a percutaneous approach were analyzed.
  
  
  RESULTS
  During the study period, 1196 breast biopsies were performed; 87 (7.3%) were open surgical biopsies, and 1109 (92.7%) were PNB. Imaging used for percutaneous guidance or needle localization was ultrasound in 58.9%, mammogram in 40.0%, and magnetic resonance imaging (MRI) in 0.9%. Open surgical excisional biopsy was associated with mammographic guidance (P < .001), location in the central or lower inner quadrant of the breast (P = .002), BIRADS score of 1 or 6 (P < .001), or calcifications as target (P < .001). There were no differences in rates of PNB by age, size of lesion, or breast density. Reasons for failure of PNB were technical (calcifications not visualized, proximity to implant, etc.) in 86.2% of cases. No reason was documented in 10.3%, and 3.4% of patients refused a percutaneous approach.
  
  
  CONCLUSIONS
  The majority of patients in this series underwent PNB as an initial diagnostic approach. Most percutaneous failures are due to technical reasons. PNB rates are a reasonable quality measure in breast cancer care. Documentation of failure to meet this benchmark should be stringently monitored.
authors.affiliation: Department of Surgery, Division of Surgical Oncology, Loma Linda University School of Medicine, Loma Linda, CA, USA.
authors.forename: Windy
authors.initials: W
authors.lastname: Olaya
authors.forename: Won
authors.initials: W
authors.lastname: Bae
authors.forename: Jan
authors.initials: J
authors.lastname: Wong
authors.forename: Jasmine
authors.initials: J
authors.lastname: Wong
authors.forename: Sharmila
authors.initials: S
authors.lastname: Roy-Chowdhury
authors.forename: Kevork
authors.initials: K
authors.lastname: Kazanjian
authors.forename: Sharon
authors.initials: S
authors.lastname: Lum
mesh_terms: D001707:Biopsy, Needle / Q000592:standards*; D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies