Exploring the Impact of Biopsy Techniques and Surgical Waiting Time on Early Breast Cancer Prognosis: a Real-World Comparative Study

Background: Preoperative biopsy techniques, including fine needle aspiration (FNA), core needle biopsy (CNB), and surgical excision, are commonly employed in early-stage breast cancer. Our study aimed to assess the impact of these three biopsy techniques on prognosis and, importantly, for the first time, to explore the effect of surgical waiting time following biopsy on survival outcomes. Methods: In this study (ChiCTR2300075857), we retrospectively analyzed medical records from breast cancer patients who underwent FNA, CNB, or excision from 2009 to 2017 and were subsequently treated with standard surgical procedures. Overall survival (OS) and disease-free survival (DFS) were examined using Kaplan‒Meier analysis and Cox proportional hazards models. Findings: The study cohort consisted of 4465, 1305, and 950 patients who underwent FNA, CNB, and excision biopsies, respectively. The median waiting period between biopsy and surgery was 5 days (IQR 3-8) in the FNA group and 8 days (IQR 4-15) in the CNB group. The majority of excision biopsies took place on the same day as the standard surgical procedure. Univariate analysis showed that the excision group had better OS (HR=0.57, p<0.01) and DFS (HR=0.69, p<0.01) compared to the FNA and CNB groups. However, after adjustment using multivariate and propensity-score matching analyses, no significant differences in OS (p=0.16) or DFS (p=0.44) were observed between the groups. Furthermore, patients with a waiting period for surgery exceeding 14 days demonstrated worse DFS both in the FNA group (p=0.022) and the excision group (p=0.047). In the CNB group, a surgical waiting time exceeding 30 days led to worse DFS (p=0.015) and OS (p=0.034). Interpretation: Despite the different biopsy techniques, the prognoses of patients were similar. Notably, this is the first study to explore the impact of surgical waiting time, and our findings suggest that reducing the interval across all groups may improve survival outcomes. However, due to the retrospective design, there is an inevitable risk of information bias, which limits the robustness of the results to some extent. Thereby, well-designed prospective studies and randomized trials are required in the future to validate the conclusion. Fundings: This research was funded by the CAMS Innovation Fund for Medical Sciences (2021-I2M-1-014) and the Beijing Hope Run Special Fund of Cancer Foundation of China (LC2022A02).