Larbert study reveals there is less need for needles now

The approach has been trialled at Forth Valley Royal Hospital
The approach has been trialled at Forth Valley Royal Hospital

Research conducted at Forth Valley Royal Hospital has shown that the number of painful and invasive breast biopsies in younger women can be halved – without the risk of missing cancer.

Dr Subodh Seth, a specialist in surgery at the Larbert hospital, presented the findings of the audit study recently to the Royal College of Surgeons in Edinburgh (RCSEd).

It showed breast lump needle biopsies could be reduced by more than 50 per cent following national evidence-based guidelines and using state-of-the-art imaging techniques. This approach, which trialled successfully at Forth Valley, also helped reduce the fear and side effects like pain, bleeding or bruising, as well as the costs associated with the procedure.

Dr Seth said: “Finding a breast lump is very distressing for women and having to then undergo a painful and traumatic biopsy just increases this distress.

“By reducing the need to take breast lump samples in certain groups of women, we can improve their healthcare experience, without the risk of missing any cancers.”

The study analysed results for close to 900 cancer cases during a five-year period in the Forth Valley area.

It concluded that a biopsy was not always needed in younger patients presenting with a solid lump.

It stated that if any malignant features were discovered, these would be evident on clinical examination or imaging – so routine core biopsies should not be advocated to rule out malignant cancer in younger patients.

The data also showed that biopsies had already reduced by more than 50 per cent since the national guidelines were introduced in 2013, without missing any cancers.

The number of younger women presenting to a one-stop clinic with palpable lumps is increasing and the incidence of breast cancer has also doubled in the last 25 years.

Previously, triple assessment was advised for the assessment of breast lumps – clinical assessment, imaging like a mammography or ultrasound and then a breast biopsy.

So all women presenting with a breast lump were recommended for a needle biopsy, regardless of age, even if their palpable lump had only benign features when examined by a doctor and via imaging.

But the study by Dr Seth found that benign tumors – non-malignant or non-cancerous tumors – were accurately detected with clinical and radiological assessment.

Therefore, breast needle biopsies were not always necessary for women younger than 25-years-old in whom breast cancer is extremely rare.

Dr Seth explained: “The quality of X-rays and ultrasounds now is so much better.

“The quality is so good that you can tell easily if it is benign.

“Of course, if there is any dubiety, then a biopsy is carried out.”

Reducing the number of biopsies benefits not only patients but medical professionals too.

The procedure can be invasive; a biopsy is taken with a 14-guage needle which is four times wider than standard injection needles.

There are also potential complications for the patient, such as infection or internal tissue blood clots.

And the number of medical professionals involved in taking and analysing the samples is vast.

Surgeons and technicians take the biopsies which pathologists analyse. Surgeons then meet with patients to deliver the results.

And, of course, there are additional administrative costs too, such as writing and sending letters of confirmation.

Dr Seth added: “There is also a week-long wait for biopsy results which in itself can be a very worrying time.”

The audit study from FVRH was presented at the annual Audit Symposium run by RCSEd earlier this year.

Mike Lavelle-Jones, president of the RCSEd, said: “Exploring statistical data regarding the effectiveness of treatments and pathways is extremely valuable to the surgical community and, by extension, to patients.

“Our Audit Symposium is an ideal platform to share knowledge and best practice on the management of health conditions – especially those that are on the rise such as breast cancer.”

* Every day, more than 140 women are diagnosed with breast cancer in the UK.