A Needle Instead Of A Knife

Margaret Walker was relieved this winter when a surgical biopsy showed that the suspicious spot on her mammogram wasn't breast cancer. Unfortunately, the test left her feeling like an accident victim. First a radiologist ran a guide wire into her breast to pinpoint the lesion. Three hours later she was wheeled into the operating room, where a surgeon dug into her breast to retrieve a tissue sample and then closed the wound with sutures. "I was home for several days, " she says. "I suffered a lot of pain, and I'll always have a scar. " The bill exceeded $5,000.

Harriet Burke got the same good news last month, but her breast biopsy was a lunch-hour errand. Burke walked into a local clinic, chatted briefly with a specialist, then relaxed on the examining table while an automated needle deftly extracted tissue samples from the affected breast. "I don't think I was in there 45 minutes total, " she says. "There was no pain at all, just a little zap. " The needle left a small bruise and a red mark, but both were gone within a week. Total bill: $850.

Every year, some 500,000 American women undergo breast biopsies. Most still endure the trauma of surgery. But as Burke's experience makes clear, an alternative is finally at hand. "There's no doubt in my mind that the majority of breast biopsies will be done this way in the future, " says Dr. Steve Parker, the Denver radiologist who pioneered the new method. "As women become aware of this option, they're not going to settle for the status quo. "

The new approach, known as stereotactic automated large-core biopsy, combines two off-the-shelf technologies: a stereoscopic X-ray device, which can pinpoint a mass within the breast, and an automated gun that uses a large needle to extract tissue. The patient simply lies face down with one breast protruding through an opening in the examining table. The X-ray machine and the needle gun are mounted underneath. After locating the suspicious mass, a radiologist adjusts the settings on the gun and slips the large needle slowly into the breast, stopping just short of the mass. When the gun is fired, a small needle juts out of the large one, collecting a tiny strip of tissue. "The patient can walk out five minutes after we finish, " Parker says. "The next day she can go skiing. "

Some experts are wary of giving up a proven technique, but the record to date suggests that automated core biopsy can be just as accurate as surgery. In a study published last summer, Parker and his colleagues reported on 102 women who had breast lesions biopsied both surgically and by the new method. In all but four of the women, both methods yielded the same results. Surgery detected two cancers that the needle missed, and the needle revealed two cancers that had eluded the surgeons. Ongoing trials at the Park-Nicollet Clinic in Minneapolis and at New York's Long Island Jewish Medical Center are turning up similar results.

Thanks to mammography screening, doctors are now spotting more breast lesions than ever before. Yet 80 to 90 percent of the suspicious lesions now being biopsied surgically turnout to be harmless. "We're headed for a situation in which every woman is a candidate for surgical biopsy at some time in her life, " says Dr. Peter Herman, head of radiology at Long Island Jewish. The new method could spare millions of women the pain and scars of surgery, and save a lot of money along the way. Assuming that each automated core biopsy costs roughly $2,000 less than surgery, Dr. William Hutchins, a Santa Barbara, Calif., radiologist, reasons that a complete switch-over could shave up to $1 billion a year off the nation's medical bill. That won't solve the health-care crisis, but it's a start.

A New Biopsy 1 The patient lies face down, putting one breast through an opening in the table. 2 A stereoscopic X-ray pinpoints a mass in the breast, then a large needle extracts a tissue sample.