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The role of breast biopsy has changed with the increased use of breast-conserving surgery for breast cancer. Between 20 and 25 percent of all operations to cure breast cancer are now breast-conserving. The traditional role of biopsy was to provide a tissue sample for examination simply to determine whether cancer was present; if found, definitive surgery was carried out, often days or weeks later. Because this excisional biopsy was performed for diagnostic purposes, there was no need to have cancer-free margins of the excised biopsy tissue specimen. It has been suggested that lumpectomy (excision of the entire mass) be used as the initial type of biopsy performed; this is believed to avoid repeat surgery if biopsy margins are tumor-free and provides a better cosmetic appearance following surgery. A study was undertaken retrospectively to compare the two methods of biopsy to assess their value in determining the course of later surgery. Forty-seven patients underwent traditional excisional biopsy, while 40 patients underwent lumpectomy. Lumpectomy took an average of 15 minutes longer to perform than traditional surgery. Cancer-free margins were present in 73 percent of the lumpectomy tissue specimens, compared with only 17 percent of the traditional excisional biopsy specimens. Patients in the lumpectomy group later on underwent more axillary dissections (removal of lymph nodes in the area of the armpit) and fewer breast removals than did the excisional biopsy group (49 percent vs 71 percent). There was a significant correlation found between patients with positive tissue margins and extensive intraductal cancer; eight of 11 patients with positive margins had ductal involvement. These findings suggest that lumpectomy is the better method for initial biopsy; it provides adequate tissue margins and may reduce the number of operations necessary. (Consumer Summary produced by Reliance Medical Information, Inc.)