Cost-effectiveness of two breast biopsy procedures: surgical biopsy versus vacuum-assisted biopsy

Stereotactic vs open biopsy for non-palpable breast lesions. Their impact on short term quality of life

Stereotactic biopsy and open biopsy represent useful diagnostic tools of breast lesions. However, both affect the Quality of Life (QoL) in various degrees. We conducted this prospective longitudinal comparative study in order, first to access the impact of these techniques on short-term QoL and second to compare and critically discuss our results with those of literature review. Group A (58 patients) underwent vacuum-assisted stereotactic biopsy and Group B (46 patients) underwent open biopsy. The Health-Related Quality of Life (HRQol) was estimated using the European Quality of Life scale (EuroQol) and the SF-36 (The 36-Item Short-Form Health Status Survey) questionnaires. The stereotactic breast biopsy seems to be more accepted from the patients as it affects quality of life to a lesser extent than open breast biopsy. This difference is mainly attributable to a reduction of physical discomfort and pain.

A Prospective Evaluation of Tru-Cut Biopsy and Fine-needle Aspiration Cytology in Male Breast Cancer Detection

BACKGROUND

Male breast-cancer (MBC) is often diagnosed late. Our purpose was to evaluate fine-needle aspiration cytology (FNAC) versus Tru-Cut biopsy (TCNB) in MBC diagnosis.

PATIENTS AND METHODS

Men with suspicious breast lesions were prospectively enrolled; 54 met the inclusion criteria and underwent FNAC and TCNB. FNAC, TCNB and gold-standard results were compared.

RESULTS

Unsatisfactory results were 11.1% after FNAC and none after TCNB (p=0.027). After gold-standard evaluation, the diagnosis of FNAC and TCNB was confirmed, respectively, in 63.0% and 98.1% and changed in 37.0% and 1.9% (p<0.001). The malignancy rate after FNAC, TCNB and surgery were, respectively, 25.9%, 33.3% and 35.1% (FNAC vs. TCNB p=0.5276, FNAC vs. surgery p=0.404; TCNB vs. surgery p=1). Among invasive carcinomas, 93.8% were identified by FNAC vs. 87.5% by TCNB (p=1); all ductal carcinoma in situ (DCIS) were detected after TCNB and none after FNAC (p=0.1).

CONCLUSION

FNAC leads to a significantly higher number of inadequate samplings and seems to be subject to increased DCIS misdiagnoses. TCNB correlated better to the final histological report.

Reduced Hospital Costs for Ultrasound-guided Vacuum-assisted Excision Compared with Open Surgery in Patients with Benign Breast Masses and High-risk Lesions

OBJECTIVE

Benign breast masses represent a substantial proportion of breast cancer screening results and may require multiple follow-up visits and biopsy. Even with a preceding benign core biopsy, benign masses have been excised via open surgery for a variety of reasons. This study compared the procedural costs of US-guided vacuum-assisted excision (US-VAE) versus open surgical excisions for benign breast masses and high-risk lesions (HRL).

METHODS

In this retrospective cohort study, female outpatients receiving US-VAE or open excision of benign breast masses between 2015 and 2018 were identified within the Premier Healthcare Database. A secondary analysis was conducted for patients with HRLs. Propensity score matching and multivariate regression adjusted for patient demographics, encounter level covariates, and hospital characteristics. The total procedural costs were reported from a hospital perspective.

RESULTS

A total of 33 724 patients underwent excisions for benign breast masses (8481 US-VAE and 25 242 open surgery). Procedural costs were significantly lower in unmatched patients who received US-VAE ($1350) versus open surgery ($3045) (P < 0.0001). After matching, a total of 5499 discharges were included in each group, with similar findings for US-VAE ($1348) versus open surgery ($3101) (P < 0.0001). A secondary analysis of matched HRL patients (41 discharges in each group) also showed significantly lower procedural costs with US-VAE ($1620) versus open surgery ($3870) (P < 0.0001).

CONCLUSION

Among patients with benign breast masses or HRLs, US-VAE was associated with significantly lower procedural costs versus open surgery. If excision is performed and expected clinical outcomes are equal, US-VAE is preferable to reduce costs without compromising the quality of care.

Cost-effectiveness of stereotactic vacuum-assisted biopsy for nonpalpable breast lesions

PURPOSE

To examine the potential cost-savings of stereotactic vacuum-assisted biopsy (SVAB) over open surgical biopsy (OSB) in diagnosis of nonpalpable lesions on mammography and to estimate the cost-saving effect on lesions at different levels of malignant probability.

METHODS

This retrospective study was approved by our Institutional Review Board. We retrospectively reviewed 276 (33.8 %) SVAB and 541 (66.2 %) OSB medical records at a medical center. Direct costs included patients' self-paid and national health insurance claim charges. Indirect costs were calculated using sick days, average salary, and age-adjusted employment rate. One-way and two-way sensitivity analyses were conducted. Lesion classification was determined by the assessment categories of Breast Imaging Reporting and Data System (BI-RADS), 4th or 5th editions.

RESULTS

SVAB decreased the direct cost by $90.3 (10.1 %) per diagnosis. The indirect cost was decreased by $560.2 (96.0 %). Overall, SVAB saved 43.9 % of resource utilization for each biopsy. Taking the cost of the subsequent malignant surgery into account, from the healthcare providers' perspective, SVAB was cost-effective if a lesion had less than 19 % likelihood of malignancy. From the societal perspective, SVAB reduced productivity loss for all the lesions. Based on the positive predictive value of the BI-RADS categories, SVAB was more suitable for the lesions of category 4A and category 3, resulting in greater savings in both medical and societal resources.

CONCLUSIONS

SVAB is a cost-effective diagnostic option for nonpalpable breast lesions. The cost-saving effect is greater for the lesions of category 4A and category 3.

Probably Benign Breast Nodular Lesions (BI-RADS 3): Correlation between Ultrasound Features and Histologic Findings

The purpose of this retrospective study was to determine the validity of the BI-RADS system in ultrasound findings assigned to BI-RADS 3 category, using cytologic and histologic results as a benchmark. Our study population consisted of 122 ultrasound nodular lesions in 122 women who underwent fine-needle aspiration cytology and biopsy for probably benign lesions (Breast Imaging Reporting and Data System [BI-RADS] category 3). Contrary to what was previously reported in the literature (risk of malignancy of BI-RADS 3 <2%), malignancy was the outcome in seven of 122 cases (5.7%). Our study also found that the presence of a cellular component with a mobile fluid-fluid level in a cystic lesion and small (<3 mm) anechoic components in solid lesions is not always an indication of benignity. Our experience seems to indicate the need to consider the presence of non-homogeneous echoes in the corpuscular cyst and solid nodular lesions with cystic components as suspicious, especially in lesions with large dimensions. Therefore it would be necessary to conduct further studies to establish a dimensional criterion in the assessment of the malignant nature of the mentioned lesions. The management of probably benign nodular lesions should not only be guided by BI-RADS classification; it is also necessary to include clinical and anamnestic data and apply a multidisciplinary approach to select cases that require histologic verification instead of the usual follow-up.

The cost effectiveness of vacuum-assisted versus core-needle versus surgical biopsy of breast lesions

OBJECTIVES

To determine the cost effectiveness of breast biopsy by 9G vacuum-assisted guided by vertical stereotaxy or ultrasonography in comparison with breast biopsy by 14G core-needle biopsy and surgical biopsy.

MATERIAL AND METHODS

We analyzed a total of 997 biopsies (181 vacuum-assisted, 626 core, and 190 surgical biopsies). We calculated the total costs (indirect and direct) of the three types of biopsy. We did not calculate intangible costs. We measured the percentage of correct diagnoses obtained with each technique. To identify the most cost-effective option, we calculated the mean ratios for the three types of biopsies.

RESULTS

Total costs were €225.09 for core biopsy, €638.90 for vacuum-assisted biopsy, and €1780.01 for surgical biopsy. The overall percentage of correct diagnoses was 91.81% for core biopsy, 94.03% for vacuum-assisted biopsy, and 100% for surgical biopsy; however, these differences did not reach statistical significance (p=0.3485). For microcalcifications, the percentage of correct diagnoses was 50% for core biopsy and 96.77% for vacuum-assisted biopsy (p<0.0001). For nodules, there were no significant differences among techniques. The mean cost-effectiveness ratio considering all lesions was 2.45 for core biopsy, 6.79 for vacuum-assisted biopsy, and 17.80 for surgical biopsy.

CONCLUSION

Core biopsy was the dominant option for the diagnosis of suspicious breast lesions in general. However, in cases with microcalcifications, the low percentage of correct diagnoses achieved by core biopsy (50%) advises against its use in this context, where vacuum-assisted biopsy would be the technique of choice because it is more cost-effective than surgical biopsy, the other technique indicated for biopsying microcalcifications.

Investigating the Generalizability of Economic Evaluations Conducted in Italy: A Critical Review

OBJECTIVES

To assess the methodological quality of Italian health economic evaluations and their generalizability or transferability to different settings.

METHODS

A literature search was performed on the PubMed search engine to identify trial-based, nonexperimental prospective studies or model-based full economic evaluations carried out in Italy from 1995 to 2013. The studies were randomly assigned to four reviewers who applied a detailed checklist to assess the generalizability and quality of reporting. The review process followed a three-step blinded procedure. The reviewers who carried out the data extraction were blind as to the name of the author(s) of each study. Second, after the first review, articles were reassigned through a second blind randomization to a second reviewer. Finally, any disagreement between the first two reviewers was solved by a senior researcher.

RESULTS

One hundred fifty-one economic evaluations eventually met the inclusion criteria. Over time, we observed an increasing transparency in methods and a greater generalizability of results, along with a wider and more representative sample in trials and a larger adoption of transition-Markov models. However, often context-specific economic evaluations are carried out and not enough effort is made to ensure the transferability of their results to other contexts. In recent studies, cost-effectiveness analyses and the use of incremental cost-effectiveness ratio were preferred.

CONCLUSIONS

Despite a quite positive temporal trend, generalizability of results still appears as an unsolved question, even if some indication of improvement within Italian studies has been observed.