Training Counts with Breast Biopsies

According to a little-noticed study published in the journal Cancer Cytopathology, the individual skill of a physician can make a significant difference in the accuracy of a fine-needle aspiration (FNA) biopsy of a breast tumor.

Fine needle aspiration uses a slender needle to remove fluid or suspicious tissue from a breast lump. The sample is then sent to a pathologist to check for cancerous cells.

Dr. Britt-Marie Ljung of the University of California at San Francisco and colleagues compared the accuracy of fine needle aspiration biopsies performed by physicians who were formally trained in the technique with physicians who were less experienced with FNA biopsies.

In total, Ljung's team compared the accuracy of 729 breast FNAs performed by seven formally trained physicians with 314 FNAs performed by 69 physicians lacking formal training in the procedure.

They found that the formally trained physicians performed an average of 100 FNA biopsies throughout the course of a year, compared to an average of only two for their less-experienced counterparts.

Importantly, this lack of formal training-and consequent lack of experience in the procedure-resulted in a significant drop in accuracy for the biopsy results. Specifically, the researchers found that the FNA biopsy specimens obtained by the physicians with formal training in the technique missed only 2 percent of the cancers, while biopsies obtained by the other physicians missed 25 percent of the cancers.

Ljung emphasized that their study findings confirmed that the sampling skill of the physician, and thus the accuracy of the biopsy itself, can vary widely-with important implications for breast cancer patients.

She recommended that physicians perform at least 150 FNA biopsies under supervision during their fellowship training. She added that hospitals might consider having only a few physicians perform FNA biopsies to help generate the high procedural volume sufficient to provide clinical expertise for the physician-and more accurate test results for the patient.

SOURCE:
Cancer Cytopathology, August 25, 2001; 93:263-268

[Table of Contents] [Archived Issues / Search] [The Breast Center]