Recommendations from the European Breast Cancer Guidelines
Should stereotactic-guided needle core biopsy or stereotactic-guided vacuum assisted needle core biopsy vs. ultrasound-guided needle core biopsy or ultrasound-guided vacuum assisted needle core biopsy be used to diagnose breast cancer in individuals with breast calcifications?
For women with calcium deposits in their breast (called calcifications or microcalcifications) that might be a sign of cancer, the ECIBC's Guidelines Development Group recommends a stereotactic-guided needle core biopsy to diagnose breast cancer rather than an ultrasound-guided needle core biopsy (strong recommendation, low certainty evidence).
- Strong recommendation against the intervention
- Conditional recommendation against the intervention
- Conditional recommendation for either the intervention or the comparison
- Conditional recommendation for the intervention
- ✓ Strong recommendation for the intervention
A recommendation can be strong or conditional.
When a recommendation is strong, most women will want to follow it. When a recommendation is conditional, the majority of women want to follow it but may need more discussion with their healthcare professional first.
What would following this recommendation mean for you?
It might be important to speak with your healthcare professional about the abnormal results of your mammogram or other screening tests.
You may wish to speak with your healthcare professional about how the stereotactic-guided needle core biopsy is performed and how you feel about
- your comfort during and after the needle core biopsy,
- any concerns you have about whether a biopsy could cause cancer to grow faster or spread,
- the chances of finding breast cancer or chances of an incorrect diagnosis, and
- what happens after you have the results of the needle core biopsy.
Who is this recommendation for?
- You had a mammogram or other screening test and the results were abnormal.
- You may have been told that you have calcium deposits in your breast, called calcifications or microcalcifications, that may or may not be a sign of cancer.
- You wish to have the lesion tested and now need a sample of tissue to be taken from your breast to test for cancer.
This recommendation, having stereotactic guided needle core biopsy for diagnosis when you have calcifications that may be the only sign of cancer, is strong because there may be greater benefits and fewer harms with stereotactic guidance than with ultrasound guidance. Benefits with stereotactic guidance are that more women may be correctly diagnosed with breast cancer than with ultrasound guidance. There may also be fewer women told they have breast cancer when in reality they do not. The stereotactic guided needle core biopsy can take a more representative sample of the lesion associated with the calcification.
The ECIBC’s Guidelines Development Group noted that equipment for stereotactic-guided needle core biopsy may not be available everywhere. This means that women may need to be referred to places where it is available.
Monitoring and EvaluationNone considered.
EvidenceDownload the evidence profile
The GDG noted that with the lower test accuracy estimate,, when using stereotactic-guided biopsy there were 27 more true positives and 27 fewer false negatives per 1000 women with calcifications compared to using ultrasound- guided biopsy (See table labelled part C).