title: Needle versus excisional biopsy for noninvasive and invasive breast cancer: report from the National Cancer Data Base, 2003-2008.
abstract: BACKGROUND
  Needle biopsy to diagnose breast cancer may soon become a quality measure for which hospitals are held accountable. This study examines the utilization of needle versus excisional biopsy in a contemporary cohort of patients and identifies factors associated with biopsy type.
  
  
  METHODS
  Women with nonmetastatic, clinical Tis-T3 breast cancers diagnosed between 2003 and 2008 were selected from the National Cancer Data Base, which captures information from ~79% of breast cancers in the United States. Patients whose cancer was diagnosed by needle biopsy (fine-needle aspiration or core) were compared with patients diagnosed via excision, analyzing patient, hospital, and tumor characteristics. Logistic regression was used to identify important predictors of biopsy type.
  
  
  RESULTS
  Of 373,837 patients, 303,677 (81.2%) underwent needle biopsy while 70,160 (18.8%) had excisional biopsy to diagnose their cancer. The needle biopsy rate increased from 73.8 to 86.7% whereas excisional biopsy declined from 26.2 to 13.3% over the study period (P < 0.001). In 2008, patients were statistically significantly more likely to undergo excisional biopsy if they had stage 0 disease; were treated at low-volume (<25 cases/year), community, or Atlantic census region hospitals; were <40 years old at diagnosis; were less educated; or were Asian/Pacific Islander (P < 0.001). The median rate of needle biopsy at high-volume hospitals (≥140 cases/year) was 89.6%.
  
  
  CONCLUSIONS
  The use of needle biopsy is increasing. Tumor stage, hospital volume, and hospital location were the most statistically significant predictors of biopsy type. Rates of needle biopsy at high-volume hospitals suggest that appropriate utilization of this preferred diagnostic method should approach 90%.
authors.affiliation: Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA.
authors.forename: Richelle T
authors.initials: RT
authors.lastname: Williams
authors.forename: Katharine
authors.initials: K
authors.lastname: Yao
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Stewart
authors.forename: David J
authors.initials: DJ
authors.lastname: Winchester
authors.forename: Mary
authors.initials: M
authors.lastname: Turk
authors.forename: Addie
authors.initials: A
authors.lastname: Gorchow
authors.forename: Nora
authors.initials: N
authors.lastname: Jaskowiak
authors.forename: David P
authors.initials: DP
authors.lastname: Winchester
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000473:pathology* / Q000601:surgery*; D018275:Carcinoma, Lobular / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011379:Prognosis