Ultrasound and Imaging Biopsy Use Can Reduce Cost of Diagnosis.(of breast cancer)

2001 FEB 15 - (NewsRx.com) -- The results of a recent study indicate that selective use of ultrasound and imaging-guided percutaneous biopsies in substitution for open surgical biopsies can significantly increase the cost effectiveness of breast carcinoma screening without decreasing the accuracy of detecting small, potentially curable lesions.

In addition, the researchers, from the University of Alabama at Birmingham (UAB), found that the accuracy of detecting carcinomas with open surgical biopsies has significantly improved over the past two decades, while the number of such procedures has proportionally steadily decreased over time with respect to the number of screening mammograms performed annually. In the 1980s, eight randomized controlled trials using screening mammography demonstrated 20%-30% mortality reductions for women older than age 50 years screened for breast cancer and a 45% reduction in mortality for women age [less than]40 years.

Since that time, technical advances and implementation of a national mammography accreditation program in the United States have resulted in more widespread application of ultrasound to characterize masses and imaging-guided biopsy to identify nonpalpable lesions. The result has been a decrease in the use of open biopsies and, subsequently, in the cost of breast carcinoma diagnosis.

At UAB, fine-needle biopsy (FNB) is usually performed for patients with solid masses with a high probability of malignancy, while ultrasound-guided core biopsy is most commonly done for solid masses that are suspected to be benign. Stereotactic core biopsy is generally applied when calcifications are detected. Patients whose core biopsy findings are discordant with imaging findings undergo open biopsy and patients diagnosed with a malignancy generally proceed to definitive therapy. Nonpalpable lesions that are likely to be benign are monitored on an annual basis.

The authors' aim in this study was to determine whether the application of ultrasound and percutaneous breast biopsies in replacement for breast biopsies in certain cases could reduce the cost associated with breast cancer screening without sacrificing accuracy and jeopardizing detection of potentially curable breast carcinomas. The researchers used the computerized mammography database at the University of Alabama to analyze record from consecutive biopsy procedures for nonpalpable mammographic abnormalities detected at the institution between 1984 and 1998. Four radiologists were responsible for interpreting 80% of the findings, and three surgical oncologists performed all surgical breast biopsies.

Data were collected on the number of examinations, surgical biopsies, tumor size, and nonpalpable cancer detection rate per 1,000, as well as patient age, race, and histologic result. The false-negative rate was determined by matching the ...