Strategy for Diagnosing Breast Cancer in Indonesia during the COVID-19 Pandemic: Switching to Ultrasound-Guided Percutaneous Core Needle Biopsy

Abstract

Strategy for Diagnosing Breast Cancer in Indonesia during the COVID-19 Pandemic: Switching to Ultrasound-Guided Percutaneous Core Needle Biopsy Farida Briani Sobri1,2*, Adang Bachtiar3, Sonar Soni Panigoro4, Juwita Cresti Rahmaania5, Patria Wardana Yuswar6, Ening Krisnuhoni7, Nelly Tandiari8 1Doctorate Student of Faculty of Public Health, Universitas Indonesia, Depok, Indonesia, 2Department of Surgical Oncology, Metropolitan Medical Centre Hospital, Jakarta, Indonesia, 3Department of Health Policy and Administration, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia, 4Department of Surgery, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia, 5Department of Surgery, Metropolitan Medical Centre Hospital, Jakarta, Indonesia, 6Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia, 7Department of Pathology, Metropolitan Medical Centre Hospital, Jakarta, Indonesia, 8Department of Radiology, Metropolitan Medical Centre Hospital, Jakarta, Indonesia Abstract In this era of COVID-19, suspected breast cancer patients experience delay in diagnosis due to the fear of contracting the virus and reduction of non-COVID- 19 health services. Furthermore, it may lead to potential increase in the incidence of advanced cancers in the future. Ultrasound-guided (US-guided) percutaneous core needle biopsy (CNB) is a great option for the diagnosis of cancer but it is poorly utilized. This study aimed to prove that the US-guided CNB is accurate when performed in a local setting and a potential solution for diagnosing breast cancer patients in this pandemic. In addition, it was a single health center cross-sectional study, and the participants were all breast cancer patients that had US-guided CNB from 2013-2019. The pathology results from US guided CNB were compared to specimens from post-CNB surgeries. The data were collected from medical records and the immunohisto chemistry (IHC) examinations were carried out for malignancy. There were 163 patients who were included in this study, 86 had malignancies and 77 had benign tumor reported in their CNB results. The US-guided CNB had 100% sensitivity and specificity compared to surgery. With its lower cost, time usage, and patient exposure to the hospital environment, US-guided CNB should replace open surgery biopsy for diagnosing suspicious breast cancers during the pandemic in Indonesia. Keywords: breast cancer, core needle biopsy, COVID-19, health cost, resources