title: Cost-effectiveness of stereotactic 11-gauge directional vacuum-assisted breast biopsy.
abstract: OBJECTIVE
  The purpose of our study was to determine the frequency with which stereotactic 11-gauge directional vacuum-assisted breast biopsy obviated a surgical procedure and to calculate cost savings attributable to that biopsy method.
  
  
  METHODS
  We retrospectively reviewed 200 consecutive solitary nonpalpable lesions on which stereotactic 11-gauge directional vacuum-assisted breast biopsy was performed. Cost savings were calculated using Medicare reimbursements. Mammograms, histologic findings, and medical records were reviewed.
  
  
  RESULTS
  Stereotactic 11-gauge directional vacuum-assisted biopsy obviated a surgical procedure in 151 (76%) of 200 lesions, including 112 (73%) of 154 calcific lesions and 39 (85%) of 46 masses. Reasons for not obviating a surgical procedure in 49 lesions (25%) included recommendation for surgical biopsy in 35 lesions (18%), small carcinomas treated by excision in 10 lesions (5%), and histologic underestimation in four lesions (2%). Stereotactic 11-gauge directional vacuum-assisted biopsy decreased the cost of diagnosis by S264 per case, a 20% ($264/$1289) decrease in the cost of diagnosis compared with surgical biopsy. Of 200 lesions that had stereotactic 11-gauge directional vacuum-assisted biopsy, 106 (53%) would not have been amenable to 14-gauge automated core biopsy because of their small size, their superficial location, or inadequate breast thickness.
  
  
  CONCLUSIONS
  Stereotactic 11-gauge directional vacuum-assisted breast biopsy obviated a surgical procedure in 76% of lesions, yielding a 20% decrease in cost of diagnosis compared with surgical biopsy. Although savings per case are modest, 11-gauge directional vacuum-assisted biopsy expands the spectrum of lesions amenable to stereotactic biopsy, increasing cost savings in the population.
authors.affiliation: Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
authors.forename: L
authors.initials: L
authors.lastname: Liberman
authors.forename: M P
authors.initials: MP
authors.lastname: Sama
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle / Q000191:economics* / Q000379:methods; D001940:Breast / Q000473:pathology*; D001941:Breast Diseases / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D014618:Vacuum