Clinical Science The evaluation of national time trends, quality of care, and factors affecting the use of minimally invasive breast biopsy and open biopsy for diagnosis of breast lesions Linda Adepoju, M.D. a , Weikai Qu, M.D., Ph.D. a , Vivian Kazan, M.D. a , Munier Nazzal, M.D., F.A.C.S. a , Mallory Williams, M.D., M.P.H., F.A.C.S. a , Joseph Sferra, M.D., F.A.C.S. b, * a Department of Surgery, Division of Surgical Education, University of Toledo Medical Center, 3000 Arlington Avenue, Toledo, OH 43615, USA; b Department of Surgery, Promedica Health System, 5800 Monroe Street Building G, Sylvania, OH 43560, USA KEYWORDS: Open breast biopsy; Minimally invasive breast biopsy; Breast cancer Abstract BACKGROUND: Minimally invasive breast biopsy is a recommended biopsy method for suspicious le- sions. This study examines national trends and factors associated with the use of open breast biopsy (OBB). METHODS: The national inpatient sample database was used to examine trends and factors associ- ated with the use of OBB. Factors associated with OBB were evaluated using chi-square test for uni- variate analysis and logistic regression for multivariate analysis. RESULTS: OBB rate was 34%. Patients below 50 years of age had OBB rates of 47%, while those above 50 had OBB rates of 29.1% (P , .001). Higher OBB rates were observed in Asian (39.8%) and Hispanic (40.6%) women compared with white women (34.1%, P , .001). Private insurance patients were more likely to have OBB compared with Medicaid/Medicare patients (40.9% vs 30.6%, P , .001). About 1.2% of women who underwent OBB required multiple biopsies for diagnosis compared with .5% for minimally invasive breast biopsy (P , .001). CONCLUSIONS: OBB is still performed in one third of women despite higher morbidity and less accuracy. Factors associated with higher OBB rate included younger age; Asian ethnicity; private in- surance; small, rural, and nonteaching hospitals. Ó 2014 Elsevier Inc. All rights reserved. The workup of any suspicious breast lesion usually includes a biopsy to obtain histologic diagnosis. Histori- cally, histologic diagnosis was obtained by performing open biopsy. The open biopsy often requires either general anesthesia or monitored anesthesia care and is usually performed in the operating room. In addition, although No current or previous support was received from industry or organizations. Presented in part at the Ohio Chapter of the American College of Surgeons Meeting, May 2012, Toledo, Ohio, and second place winner commission on Cancer Physician in Training Paper Competition 2012 * Corresponding author. Tel.: 11-419-291-5722; fax: 11-419-479-6030. E-mail address: joseph.sferramd@promedica.org Manuscript received August 10, 2013; revised manuscript January 16, 2014 0002-9610/$ - see front matter Ó 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.amjsurg.2014.02.008 The American Journal of Surgery (2014) 208, 382-390