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Cost Minimization Study of Image-Guided Core Biopsy Versus Surgical Excisional Biopsy for Women With Abnormal Mammograms

From the Division of General Internal Medicine, and Department of Medicine, The Lynn Sage Comprehensive Breast Center; the Department of Surgery, Northwestern University Feinberg School of Medicine; the VA Midwest Center for Health Services and Policy Research, Lakeside Division; the Division of Hematology/Oncology, Department of Medicine; the Center for Healthcare Studies; and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University Medical Center, Chicago IL

Address reprint requests to Charles Bennett, MD, PhD, VA Lakeside Medical Center, Division of General Internal Medicine, Department of Medicine, 400 E Ontario, Suite 204, Chicago IL 60611; e-mail: cbenne{at}northwestern.edu

PURPOSE: To describe the clinical and economic consequences of image-guided core biopsy versus surgical excisional biopsy of mammographically identified breast lesions.

PATIENTS AND METHODS: Clinical and economic data were collected for 1,121 patients undergoing core biopsies and 501 patients undergoing surgical biopsies between 1996 and 1998. Lesions were classified according to mammographic degree of suspicion and type of radiographic abnormality. Costs were measured from the societal perspective. A decision analytic model was constructed, with probabilistic sensitivity analysis.

RESULTS: Lesions diagnosed via core versus surgical biopsy were less likely to be masses (39% v 55%), less likely to be classified as high cancer suspicion (17% v 26%), and less likely to be treated with a single procedure (74% v 81%; P < .001 for each). Cancers diagnosed by a surgical biopsy were less likely to have had a single operative procedure (33% v 84%) and were associated with higher total costs whether mastectomy ($2,775 v $1,849) or lumpectomy ($2,112 v $1,365) was used. Sensitivity analysis showed core biopsy optimal in 95.4% of trials. Core biopsy was favored for low-suspicion lesions, calcifications, and masses, and overall for patients who underwent lumpectomy alone.

CONCLUSION: Image-guided core biopsy can be cost-saving compared with surgical biopsy, particularly when the mammographic abnormality is classified as low suspicion or consists of calcifications or masses. Moving to a policy in which core biopsy is the preferred approach in these settings has the potential to result in significant cost savings.

Supported by Department of the Army Medical Research and Development Command grant 17-96-2-6013.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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