title: The cost effectiveness of vacuum-assisted versus core-needle versus surgical biopsy of breast lesions.
abstract: OBJECTIVE
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Servicio de Radiología Diagnóstica y Terapéutica, Hospital General Universitario de Castellón, Castellón, España. Electronic address: pifernan@uji.es.
authors.forename: P
authors.initials: P
authors.lastname: Fernández-García
authors.affiliation: Servicio de Radiología Diagnóstica y Terapéutica, Hospital General Universitario de Castellón, Castellón, España; Departamento de Medicina, Universidad Jaime I, Castellón, España.
authors.forename: S F
authors.initials: SF
authors.lastname: Marco-Doménech
authors.affiliation: Outcomeś10, Universidad Jaime I, Castellón, España.
authors.forename: L
authors.initials: L
authors.lastname: Lizán-Tudela
authors.affiliation: Departamento de Matemáticas, IMAC, Universidad Jaime I, Castellón, España.
authors.forename: M V
authors.initials: MV
authors.lastname: Ibáñez-Gual
authors.affiliation: Servicio de Radiología Diagnóstica y Terapéutica, Hospital General Universitario de Castellón, Castellón, España.
authors.forename: A
authors.initials: A
authors.lastname: Navarro-Ballester
authors.affiliation: Servicio de Radiología Diagnóstica y Terapéutica, Hospital General Universitario de Castellón, Castellón, España.
authors.forename: E
authors.initials: E
authors.lastname: Casanovas-Feliu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000191:economics / Q000379:methods; D001707:Biopsy, Needle / Q000191:economics; D001943:Breast Neoplasms / Q000191:economics* / Q000473:pathology*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D014618:Vacuum; D055815:Young Adult
keywords: Biopsia mamaria asistida por vacío; Biopsia mamaria con aguja gruesa; Biopsia mamaria quirúrgica; Core-needle breast biopsy; Cost effectiveness; Costo-efectividad; Surgical breast biopsy; Vacuum-assisted breast biopsy