Should all breast cancers be diagnosed by needle biopsy?

Background Although much data support the National Quality Forum recommendation that breast cancers should be diagnosed by needle biopsy before surgical resection, the exclusion criteria for those that may not be suitable have yet to be defined. Methods We reviewed all patients treated over the past 3 years at the Yale Breast Center to determine the percentage of patients not diagnosed by needle biopsy, and why. Results Reasons for the 17% of 630 patients who were not diagnosed by needle biopsy were as follows: inability to cooperate (1%); small or superficial lesion less than 1 cm that technically was easier to excise in the office (4%); bloody discharge without clinical or mammographic mass (1%); lesion adjacent to implant (.5%); a mammographic lesion that was too posterior, too superficial, or too faint to be performed stereotactically (5%); or patient preference (5%). Conclusions Needle biopsy is the preferred method of diagnosis in most cases, but there are valid reasons why all breast cancers will not be diagnosed in this fashion.