title: Efficacy and cost-effectiveness of stereotactic vacuum-assisted core biopsy of nonpalpable breast lesions: analysis of 602 biopsies performed over 5 years.
abstract: OBJECTIVE
  The authors sought to evaluate the diagnostic accuracy and cost-effectiveness of vacuum-assisted core biopsy (VACB) in comparison with diagnostic surgical excision for characterisation of nonpalpable breast lesions classified as Breast Imaging Reporting and Data System (BI-RADS) categories R3 and R4.
  
  
  METHODS
  From January 2004 to December 2008, we conducted 602 stereotactic, 11-gauge, VACB procedures on 243 nonpalpable breast lesions categorised as BI-RADS R3, 346 categorised as BI-RADS R4 and 13 categorised as BI-RADS R5. We calculated the diagnostic accuracy and cost savings of VACB by subtracting the cost of the stereotactic biopsy from that of the diagnostic surgical procedure.
  
  
  RESULTS
  A total of 56% of the lesions were benign and required no further assessment. Lesions of uncertain malignant potential (B3) (23.6%) were debated at multidisciplinary meetings, and diagnostic surgical biopsy was recommended for 83.1% of them. All malignant lesions (B4 and B5) underwent surgical excision. VACB had a sensitivity of 94.9%, specificity of 98.3% and diagnostic accuracy of 97.7%. The cost savings per VACB procedure were 464.00 euro; by obviating 335 surgical biopsies, the overall cost savings was 155,440.00 euro over 5 years.
  
  
  CONCLUSIONS
  VACB proved to have high diagnostic accuracy for characterising abnormalities at low to intermediate risk of malignancy and obviated surgical excision in about half of the cases, allowing for considerable cost savings.
authors.affiliation: Istituto di Radiologia Diagnostica ed Interventistica, Università di Torino, ASO San Giovanni Battista di Torino, Sede Molinette, Via Genova 3, 10126, Torino, Italy. andrea.luparia@hotmail.it
authors.forename: A
authors.initials: A
authors.lastname: Luparia
authors.forename: M
authors.initials: M
authors.lastname: Durando
authors.forename: P
authors.initials: P
authors.lastname: Campanino
authors.forename: E
authors.initials: E
authors.lastname: Regini
authors.forename: D
authors.initials: D
authors.lastname: Lucarelli
authors.forename: A
authors.initials: A
authors.lastname: Talenti
authors.forename: G
authors.initials: G
authors.lastname: Mattone
authors.forename: G
authors.initials: G
authors.lastname: Mariscotti
authors.forename: A
authors.initials: A
authors.lastname: Sapino
authors.forename: G
authors.initials: G
authors.lastname: Gandini
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle / Q000191:economics*; D001941:Breast Diseases / Q000473:pathology*; D002114:Calcinosis / Q000473:pathology; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008875:Middle Aged; D013238:Stereotaxic Techniques / Q000191:economics*; D014618:Vacuum