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

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 stereotacticguided LCNB. Stereotactic-guided LCNB was significantly more cost effective than WL-OSE, showing an average savings of $1,750 per procedure. These data indicate imagingguided 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 p open excisional biopsy. Both core biopsy techniques provided accurate histological diagnoses.