Are breast biopsy markers underused?

Abstract

Introduction To evaluate current use of breast biopsy markers (BBM) amongst Australian and New Zealand radiologists. Methods Radiologists attending a national breast conference were invited to complete an online survey addressing demographics, BBM use following ultrasound, stereotactic, tomosynthesis and MRI‐guided biopsy, frequency of early BBM displacement, preoperative lesion localisation (PLL) and axillary BBM use. Results Overall response rate was 52% (60/115). The majority (n = 45) 75% practiced in Australia. 98% had BBMs available in their practice, 40% reported BBM costs weren’t covered by insurance. 27% would use BBMs more often if they were, with some utilising smaller gauge devices for lesion sampling to minimise need for BBM use and patient out‐of‐pocket costs. Ultrasound‐guided procedures were associated with lower rates of clinically significant BBM displacement (P = 0.001). Considering PLL, 44% were able to perform US‐guided PLL in <25% of cases. Poor sonographic visibility was the commonest reason why this wasn’t possible. In the axilla, BBMs were mainly used to mark positive nodes in pre‐neoadjuvant chemotherapy patients. Conclusion This survey is the first to provide data on BBM use amongst a sample of predominantly Australian and New Zealand radiologists, and provides compelling evidence of significantly lower incidence of BBM displacement with US‐guided procedures. Our results suggest some radiologists may hesitate to use BBMs due to cost, and this can influence their choice of biopsy technique. Provision of a Medicare item Number for BBMs may lead to increased adoption of best practice guidelines for preoperative diagnosis of breast lesions.

Evaluating breast biopsy practice and breast biopsy marker utilisation in the clinical setting

“…11 A total of 277 respondents makes this the largest global study that we are aware of evaluating BBM use. 2,10 Most (72%) respondents are placing between 1 and 4 BBMs per week, of these 78% would always perform a post-BBM mammogram. The majority (57%) of respondents consider clinically significant BBM displacement to be >10 mm between BBM and lesion site on a two-view mammogram, similar to findings from the study by Frost et al, 10 who reported that 51% of radiologists consider significant displacement to be >10 mm from the lesion.…”

“…2,10 Most (72%) respondents are placing between 1 and 4 BBMs per week, of these 78% would always perform a post-BBM mammogram. The majority (57%) of respondents consider clinically significant BBM displacement to be >10 mm between BBM and lesion site on a two-view mammogram, similar to findings from the study by Frost et al, 10 who reported that 51% of radiologists consider significant displacement to be >10 mm from the lesion. Some respondents indicated that any BBM displacement is significant and should be documented.…”

“…Most respondents (85%) routinely perform breast biopsy under stereotactic or tomosynthesis guidance, similar to the rate reported by Frost et al (81%). 10 Just over half of the respondents (51%) would always place a BBM post-stereotactic-guided biopsy. This finding is significantly different from that of Frost et al, 10 where 100% of surveyed radiologists reported that they would always deploy a BBM post-stereotactic or tomosynthesisguided biopsy; however, is aligned with a rate of 51% reported by Thomassin-Naggara et al 2 Almost all (99%) respondents routinely perform breast biopsy under ultrasound guidance, aligned with the 96% reported by Thomassin-Naggara et al 2 Almost all (98%) of 267 question participants indicated that they routinely perform axillary node biopsy under ultrasound guidance, significantly higher than the 66% reported by Frost et al Reasons for this discrepancy are unclear, however, presumably relate to differing practices between the study populations or alternatively bias from smaller sample size (n = 52) in the prior study.…”

“…10 Just over half of the respondents (51%) would always place a BBM post-stereotactic-guided biopsy. This finding is significantly different from that of Frost et al, 10 where 100% of surveyed radiologists reported that they would always deploy a BBM post-stereotactic or tomosynthesisguided biopsy; however, is aligned with a rate of 51% reported by Thomassin-Naggara et al 2 Almost all (99%) respondents routinely perform breast biopsy under ultrasound guidance, aligned with the 96% reported by Thomassin-Naggara et al 2 Almost all (98%) of 267 question participants indicated that they routinely perform axillary node biopsy under ultrasound guidance, significantly higher than the 66% reported by Frost et al Reasons for this discrepancy are unclear, however, presumably relate to differing practices between the study populations or alternatively bias from smaller sample size (n = 52) in the prior study. 10 Common indications for BBM placement following axillary node biopsy include in the setting of neoadjuvant therapy, and at the request of the surgeon or other clinician, similar to the findings of Frost et al 10 About a quarter (27%) of study participants report that they routinely perform MRI-guided breast biopsy, closely correlating with the 28% reported by Frost et al This finding reflects the emergence of MRI-guided breast biopsy as a relatively recent diagnostic procedure, with utilisation by fewer radiologists when compared to ultrasound and tomosynthesis/stereotactic-guided procedures.…”

“…To our knowledge, this is the largest survey to date that addresses both BBM use in clinical practice and the factors influencing utilisation of markers. 2,10 'breast imaging' as their area of interest or practice in the Royal Australian and New Zealand College of Radiologists (RANZCR) customer relationship management system (online membership portal). A link to the survey was disseminated to 835 practitioners and was available to be accessed over 3 weeks from 3rd February to 24th February, 2020.…”