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

• Published in: Cancer Vol. 82; no. 10; pp. 1867 - 1873
• Main Authors: Logan‐Young, Wende, Dawson, Andrea E., Wilbur, David C., Avila, Eduardo E., Tomkiewicz, Zygmunt M., Sheils, Lucy A., Laczin, John A., Taylor, Andrea S.
• Format: Journal Article
• Language: English
• Published: New York John Wiley & Sons, Inc 15-05-1998; Wiley-Liss
• Subjects: 14‐gauge core needle biopsy; Biological and medical sciences; Biopsy, Needle - economics; Biopsy, Needle - instrumentation; Breast; breast carcinoma; Breast Neoplasms - diagnosis; Breast Neoplasms - diagnostic imaging; Breast Neoplasms - pathology; Cost-Benefit Analysis; cost‐effectiveness; Female; fine‐needle aspiration cytology; Genital system. Mammary gland; Humans; Investigative techniques, diagnostic techniques (general aspects); Mammography; Mass Screening - economics; Mass Screening - methods; Medical sciences; New York; open surgical biopsy/carcinoma ratio; Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques; Predictive Value of Tests; Surgical biopsy; Human; Carcinoma; Malignant tumor; Aspiration punction; Pathology; Mammary gland diseases; Histopathology; Fine needle; Biopsy; Surgery; Needle; Diagnosis; Mammary gland; Cost efficiency analysis
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/(SICI)1097-0142(19980515)82:10<1867::AID-CNCR8>3.0.CO;2-K

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. Cancer 1998;82:1867‐73. © 1998 American Cancer Society.
A freestanding breast clinic's use of fine‐needle aspiration cytology and 14‐gauge core needle biopsy was found to be a cost‐effective way to spare women from unnecessary open surgical biopsies without compromising breast carcinoma detection. Utilization of these methods resulted in a cost savings of > $1,000,000 in 1 year.