title: The cost-effectiveness of fine-needle aspiration cytology and 14-gauge core needle biopsy compared with open surgical biopsy in the diagnosis of breast carcinoma.
abstract: BACKGROUND
  Judicious utilization of fine-needle aspiration cytology (FNAC) and 14-gauge core needle biopsy (CB) theoretically should result in greater accuracy in breast carcinoma diagnosis and fewer unnecessary open surgical biopsies (OSBs), thus lowering health care costs.
  
  
  METHODS
  In 1995 in Rochester, New York, the ratio of open surgical breast biopsies per each verified breast carcinoma (OSB/Ca) in a freestanding breast clinic (EWBC) was compared with the OSB/Ca ratio of all physicians in the remainder of the city. The EWBC differs from all other diagnostic facilities in Rochester in that it routinely performs FNAC and CB.
  
  
  RESULTS
  The EWBC recommended 462 OSBs resulting in 310 verified carcinomas, for a OSB/Ca ratio of 1.5. The physicians in the remainder of the city recommended 2036 OSBs resulting in 513 verified carcinomas, for a OSB/Ca ratio of 4.0. If the EWBC OSB/Ca ratio had been identical to the remainder of the city, the number of extra OSBs recommended by the clinic would have been 778, resulting in an additional cost of $1,712,082. When the added cost of the 2594 FNACs ($256,285) and 403 CBs ($252,278) performed by the clinic was subtracted from the $1,712,082, the freestanding breast clinic cost savings was $1,203,519. The lymph node metastasis rate of 19% for the breast carcinomas diagnosed in clinic patients was identical to that of the women with breast carcinoma in the remainder of the city.
  
  
  CONCLUSIONS
  Utilization of FNAC and CB allows radiologists to lower their OSB/Ca ratio without sacrificing early detection. In this study, these less expensive procedures result in lowered medical costs for the health care system.
authors.affiliation: The Elizabeth Wende Breast Clinic, Rochester, New York, USA.
authors.forename: W
authors.initials: W
authors.lastname: Logan-Young
authors.forename: A E
authors.initials: AE
authors.lastname: Dawson
authors.forename: D C
authors.initials: DC
authors.lastname: Wilbur
authors.forename: E E
authors.initials: EE
authors.lastname: Avila
authors.forename: Z M
authors.initials: ZM
authors.lastname: Tomkiewicz
authors.forename: L A
authors.initials: LA
authors.lastname: Sheils
authors.forename: J A
authors.initials: JA
authors.lastname: Laczin
authors.forename: A S
authors.initials: AS
authors.lastname: Taylor
mesh_terms: D001707:Biopsy, Needle / Q000191:economics* / Q000295:instrumentation; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008327:Mammography; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D009518:New York; D011237:Predictive Value of Tests