Jacky Luiten

Utility of diagnostic breast excision biopsies during two decades of screening mammography | 43 3 if the increase in the use of these excision biopsies can be considered as an improvement in the diagnostic process. Proponents might prefer to proceed to an excision biopsy to gain a definitive pathology result claiming that over 25% of the high‐risk lesions show a (pre‐) malignant pathology result after surgical excision. Others might state that these lesions may be safely managed by active radiographic surveillance, knowing that the majority of these lesions are low grade DCIS. Actually, this issue is currently subject of several ongoing studies. 27,28 One may question whether our current approach of high‐risk mammographic lesions may be too defensive and results in too many unnecessary surgical excisions. In a recent survey amongst breast pathologists in the United States, almost 90% reported using one or more assurance behaviors, manifesting itself in ordering additional services with marginal or no additional medical value to avoid adverse patient outcomes. 29 This phenomenon is understandable, since a delay in diagnosis of breast cancer is a leading cause of malpractice suits filed in the United States. 30 The rate of excision biopsy procedures is much higher in the United States compared to European countries, including the Netherlands and the United Kingdom. This higher excision biopsy rate may be due to differences in legislation, with a higher rate of malpractice claims for delayed cancer diagnoses in the US than in Europe. 11,31 Unfortunately, we were not able to reliably retrieve the detailed considerations to proceed to a secondary excision biopsy as these were frequently not specified in the multidisciplinary tumor board reports. In conclusion, following a sharp decline of the overall excision biopsies rate, a significant increase of secondary excision biopsies was noted the last few years. Since the vast majority of all excision biopsies performed nowadays is benign, secondary excision biopsy should only be considered for women in whom radiologic surveillance and repeated percutaneous biopsy continues to yield indeterminate result.