A comparison of medicare reimbursement and results for various imaging-guided breast biopsy techniques

Abstract

The Medicare population makes up a large proportion of the patients who undergo evaluation and treatment of mammographically detected breast lesions. In the past, the standard approach for obtaining a histological specimen for definitive diagnosis has been wire localization followed by open surgical excision (WL-OSE). In recent years, however, imaging-guided large core needle biopsy (LCNB) has been investigated as a more cost effective and less invasive alternative. The authors examined accuracy and reimbursement of ultrasound-guided LCNB, stereotactic-guided LCNB, and WL-OSE in 139 Medicare patients who demonstrated abnormalities on screening mammograms in 1994 and 1995. Ultrasound-guided LCNB was used to diagnose 20% of these cases, sterotactic LCNB was used to diagnose 68% of the cases, and the remaining 12% were diagnosed using WL-OSE. Histological diagnoses for 54 LCNBs (20 ultrasound-guided and 34 stereotactic-guided) were 98% accurate when compared with a subsequent surgical excision specimen. Ultrasound-guided LCNB was the most cost-effective approach, showing an average savings of $1,960 per procedure over WL-OSE and $211 over stereotactic-guided LCNB. Stereotactic-guided LCNB was significantly more cost effective than WL-OSE, showing an average savings of $1,750 per procedure. These data indicate imaging-guided LCNB to be a reasonable alternative to WL-OSE for definitive histological diagnosis of nonpalpable breast lesions. Ultrasound-guided imaging was shown to be applicable in 20% of the cases and is the least expensive to the Medicare system. The stereotactic approach can be used for a much larger percentage of these patients and although not as cost effective as ultrasound, it is considerably more cost effective than open excisional biopsy. Both core biopsy techniques provided accurate histological diagnoses.