Clinical and cost outcomes associated with multiple open procedures following percutaneous breast biopsy in Medicare patients.

Abstract

e12083 Background: Percutaneous core-needle biopsy (PCNB) is the standard of care to diagnose suspicious lesions of the breast. Dependent upon histology, many women require additional open procedures for definitive diagnosis and excision. However, there remains little nationally-representative research on the proportion of women undergoing multiple open biopsy or lumpectomy procedures and the associated incremental burden to the health system. Methods: This study used Medicare 100% Standard Analytic Files (2010–2014) to identify patients undergoing PCNB in an outpatient setting. Patients included females aged ≥65; continuous Medicare enrollment; no history of cancer, chemotherapy, radiation or breast cancer surgery in the prior year. Open procedures were defined as an open biopsy or lumpectomy. Study follow-up was defined as 90 days from initial PCNB or until the day prior to chemotherapy, radiation, or mastectomy—to limit analysis to diagnosis-related payments. Payments were defined as Medicare payments. Results: 110,944 patients were identified; the mean age was 73.5; 74.1% underwent only PCNB, 23.8% had one open procedure and 2.1% had multiple open procedures. Among the PCNB-only cohort, 2.7% had multiple PCNBs; among those with subsequent open procedures, 4.1-4.4% had multiple PCNBs (P < .001). Incidence of all-cause complications was significantly lower among those with no open procedure (8%) versus those with one (11%) or more (20%, P < .001). Mean incremental breast-related payments were $3003 greater among those with one open procedure versus none ($4526 v $1523, P < .001), and $1978 greater among those with multiple open procedures ($6504 v $4526, P < .001). Prior receipt of multiple PCNBs and diagnosis of breast cancer were significantly positively correlated in logistic regression with having multiple open procedures, while age ≥ 80 was a negative predictor. Conclusions: There continues to be a percentage of women that require multiple open procedures following initial biopsy. These results suggest that incomplete excision at the first open procedure remains a meaningful concern, and merits further investigation into methods to ensure excisional completeness.