title: Diagnostic workup and costs of a single supplemental molecular breast imaging screen of mammographically dense breasts.
abstract: OBJECTIVE
  The purpose of this study was to examine additional diagnostic workup and costs generated by addition of a single molecular breast imaging (MBI) examination to screening mammography for women with dense breasts.
  
  
  METHODS
  Women with mammographically dense breasts presenting for screening mammography underwent adjunct MBI performed with 300 MBq (99m)Tc-sestamibi and a direct-conversion cadmium-zinc-telluride dual-head gamma camera. All subsequent imaging tests and biopsies were tracked for a minimum of 1 year. The positive predictive value of biopsies performed (PPV3), benign biopsy rate, cost per patient screened, and cost per cancer detected were determined.
  
  
  RESULTS
  A total of 1651 women enrolled in the study. Among the 1585 participants with complete reference standard, screening mammography alone prompted diagnostic workup of 175 (11.0%) patients and biopsy of 20 (1.3%) and yielded five malignancies (PPV3, 25%). Results of combined screening mammography plus MBI prompted diagnostic workup of 279 patients (17.6%) and biopsy of 67 (4.2%) and yielded 19 malignancies (PPV3, 28.4%). The benign biopsy rates were 0.9% (15 of 1585) for screening mammography alone and 3.0% (48 of 1585) for the combination (p < 0.001). The addition of MBI increased the cost per patient screened from $176 for mammography alone to $571 for the combination. However, cost per cancer detected was lower for the combination ($47,597) than for mammography alone ($55,851).
  
  
  CONCLUSIONS
  The addition of MBI to screening mammography of women with dense breasts increased the overall costs and benign biopsy rate but also increased the cancer detection rate, which resulted in a lower cost per cancer detected than with screening mammography alone.
authors.affiliation: 1 Department of Radiology, Mayo Clinic Rochester, 200 First St SW, Rochester, MN 55905.
authors.forename: Carrie B
authors.initials: CB
authors.lastname: Hruska
authors.forename: Amy Lynn
authors.initials: AL
authors.lastname: Conners
authors.forename: Katie N
authors.initials: KN
authors.lastname: Jones
authors.forename: Michael K
authors.initials: MK
authors.lastname: O'Connor
authors.forename: James P
authors.initials: JP
authors.lastname: Moriarty
authors.forename: Judy C
authors.initials: JC
authors.lastname: Boughey
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Rhodes
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000191:economics*; D055088:Early Detection of Cancer / Q000191:economics*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008327:Mammography / Q000191:economics*; D008875:Middle Aged; D057054:Molecular Imaging / Q000191:economics*; D049268:Positron-Emission Tomography / Q000191:economics*; D015995:Prevalence; D019275:Radiopharmaceuticals / Q000191:economics; D017256:Technetium Tc 99m Sestamibi / Q000191:economics; D014481:United States / Q000453:epidemiology
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi
keywords: benign biopsy rate; breast density; costs; molecular breast imaging; supplemental screening