Jacky Luiten

38 | Chapter 3 Figure 3.1 Number of women undergoing a surgical excision biopsy per 1000 screens. Trends in primary and secondary excision biopsies During the past two decades, 411 (45.3%) excision biopsies were performed as first diagnostic intervention (primary excision biopsy), compared to 497 (54.7%) performed following previous percutaneous biopsies (secondary excision biopsy). During the first screening period 1997‐1998, a primary excision biopsy was performed in 167 (78.0%) of all 214 patients who underwent excision biopsy, which decreased to 0 out of 84 in the last cohort ( p <0.001). In the last decade, only 24 recalled women underwent a surgical excision biopsy as the first diagnostic intervention, mostly due to inability to perform a stereotactic core needle biopsy (SCNB). The use of secondary excision biopsies among the patients undergoing an excision biopsy increased from 22.0% (47 out of 214) in 1997‐1998, to 100% (84 out of 84) in 2015‐2016. The majority (286, 57.8%) of the 495 secondary excision biopsies were performed because of pathologic findings at percutaneous biopsy for which pathologists were unable to guarantee a benign disorder. Discordance between radiologic findings and the result of percutaneous biopsy was the reason to perform an excision biopsy secondary to percutaneous biopsy in 109 patients (22.0%); other indications for a secondary excision biopsy are specified in Table 3.1. The observed increase in secondary excision biopsies was mostly due to an increase in suspicious findings at percutaneous biopsy, while the other reasons for secondary excision showed no increase or other trend during this period (Table 3.1).