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ULTRASOUND-AIDED BREAST BIOPSY AVOIDS MANY SURGICAL BIOPSIES AND COSTS LESS THAN HALF AS MUCH

Oak Brook, IL -- A new study released in the September issue of the monthly scientific journal, Radiology, "US-guided Core Breast Biopsy: Use and Cost- Effectiveness," by Liberman, et al, indicates that the use of ultrasound (US) guided core biopsy of nonpalpable breast lesions rather than surgical biopsy could result in a substantial (approximately $60,000,000) annual savings in the costs of diagnosis of breast cancer.
As recently as 5 years ago, the many women whose mammogram showed a suspicious breast lump that could not be felt had no choice but to undergo an invasive procedure called needle localization breast biopsy. Using the mammogram as a guide, the radiologist places a wire directly into the lump, and the surgeon then removes the wire with the tissue surrounding it. This is an emotionally challenging procedure, especially for women with benign breast disease who might need repeated biopsies. Further, each biopsy removes breast tissue and causes some degree of scarring within the breast. Undoubtedly many women have avoided periodic mammography out of fear that they might need a surgical biopsy.
In 1993, Dr. Steven Parker and his colleagues pioneered a percutaneous (through-the-skin) method: ultrasound (US) guided core breast biopsy. This is a highly accurate and much less invasive way of assessing suspicious breast lumps. With the woman lying on her back and turned slightly to the side, a US probe is placed directly over the site of the lump and, with use of local anesthesia, the radiologist places a "cutting needle" directly into the mass. Two to seven specimens are quickly taken using an automatic spring-loaded device. The entire procedure takes only 10 to 20 minutes, and the patient returns home later the same day. In Parker's initial study of 49 women who later had their lumps removed, diagnoses based on the US-guided biopsies were 100% accurate.
Apart from being a much easier and less traumatic method, US-aided core biopsy is less costly: Medicare currently reimburses $385, compared to $1,332 for surgical biopsy. To learn just how much is saved, Laura Liberman, MD, and colleagues at Memorial Sloan-Kettering Cancer Center in New York City reviewed their experience with US-guided biopsies in 151 consecutive women with breast masses discovered with mammography but not felt in the breast. The policy was to perform surgery if the findings were malignant or suspicious, and to repeat mammography a year later if the findings were benign. The study, reported in Radiology, showed that no fewer than 85% of these women were spared biopsy, and overall diagnostic costs were reduced 56%. Importantly, none of 72 women who were followed up for about a year developed cancer.
Another percutaneous method of evaluating suspect breast masses, stereotactic biopsy, involves the use of mammography in place of US to guide needle placement. It is an excellent way of evaluating the tiny calcium deposits found in about half of all breast cancers (US doesn't do this very well). But the US-guided method is faster, avoids radiation, and can assess lumps in the axilla or near the chest wall that are hard to access with stereotactic biopsy. Had the stereotactic method rather than US-guided biopsy been used in the same women, the cost savings compared to surgical biopsy would have been 39% -- still substantial, but less impressive than with the US-aided biopsy.
The investigators estimate conservatively that replacing most standard operative biopsies for breast lumps that cannot be felt with the US-guided percutaneous method could have saved nearly $60 million nationally in 1998. Says Dr. Liberman, "It is my hope and the hope of my coworkers that more women will undergo regular mammography if they know that we can now in many cases evaluate breast abnormalities using techniques that are faster, less invasive, and less expensive than surgery." Radiology is a monthly scientific journal devoted to clinical radiology and allied sciences. The journal is edited by Anthony V. Proto, MD, Medical College of Virginia of Virginia Commonwealth University, Richmond, Va. It is owned and published by the Radiological Society of North America, Inc.

[US-Guided Core Breast Biopsy: Use and Cost-Effectiveness, L. Liberman et al. Corresponding author: Laura Liberman, M.D.]

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