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 the presence of breast cancer in individuals presenting with breast calcifications?
- 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.
The GDG noted that while stereotactic guidance is favourable, in practice there was low certainty in the evidence reviewed that compared stereotactic to ultrasound guidance. Despite this, the GDG agreed that, when comparing stereotactic-guided NCB with open biopsy, the recommendation was strong and the certainty of this evidence was high. However, when comparing stereotactic guidance to ultrasound guidance, as there were no studies directly comparing both interventions, the overall certainty of the evidence was low, due to the low quality of the evidence for ultrasound guidance compared to open biopsy, as well as the fact that only two studies were found on ultrasound guidance. The GDG agreed to issue a strong recommendation in favour of the use of stereotactic guidance for biopsy evaluation of breast calcification despite the low certainty of the evidence. The radiologist GDG members advised the group that this technique poses less risk for the individual and permits accurate visualisation and targeted biopsy of the calcification. The GDG histopathologists confirmed that their experience indicates that stereotactic-guided biopsy is far superior to ultrasound-guided biopsy in obtaining representative tissue samples of calcification for microscopic evaluation.
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).