title: Trends in breast biopsies for abnormalities detected at screening mammography: a population-based study in the Netherlands.
abstract: BACKGROUND
  Diagnostic surgical breast biopsies have several disadvantages, therefore, they should be used with hesitation. We determined time trends in types of breast biopsies for the workup of abnormalities detected at screening mammography. We also examined diagnostic delays.
  
  
  METHODS
  In a Dutch breast cancer screening region 6230 women were referred for an abnormal screening mammogram between 1 January 1997 and 1 January 2011. During two year follow-up clinical data, breast imaging-, biopsy-, surgery- and pathology-reports were collected of these women. Furthermore, breast cancers diagnosed >3 months after referral (delays) were examined, this included review of mammograms and pathology specimens to determine the cause of the delays.
  
  
  RESULTS
  In 41.1% (1997-1998) and in 44.8% (2009-2010) of referred women imaging was sufficient for making the diagnosis (P<0.0001). Fine-needle aspiration cytology decreased from 12.7% (1997-1998) to 4.7% (2009-2010) (P<0.0001), percutaneous core-needle biopsies (CBs) increased from 8.0 to 49.1% (P<0.0001) and surgical biopsies decreased from 37.8 to 1.4% (P<0.0001). Delays in breast cancer diagnosis decreased from 6.7 to 1.8% (P=0.003).
  
  
  CONCLUSIONS
  The use of diagnostic surgical breast biopsies has decreased substantially. They have mostly been replaced by percutaneous CBs and this replacement did not result in an increase of diagnostic delays.
authors.affiliation: Department of Radiology, Catharina Hospital, Eindhoven, The Netherlands. vivianvbreestsm@hotmail.com
authors.forename: V
authors.initials: V
authors.lastname: van Breest Smallenburg
authors.forename: J
authors.initials: J
authors.lastname: Nederend
authors.forename: A C
authors.initials: AC
authors.lastname: Voogd
authors.forename: J W W
authors.initials: JW
authors.lastname: Coebergh
authors.forename: M
authors.initials: M
authors.lastname: van Beek
authors.forename: F H
authors.initials: FH
authors.lastname: Jansen
authors.forename: W J
authors.initials: WJ
authors.lastname: Louwman
authors.forename: L E M
authors.initials: LE
authors.lastname: Duijm
mesh_terms: D001707:Biopsy, Needle / Q000639:trends*; D001940:Breast / Q000502:physiology; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008327:Mammography; D008403:Mass Screening; D009426:Netherlands