STEREOTACTIC CORE BIOPSY REDUCES THE REEXCISION RATE AND THE COST OF MAMMOGRAPHICALLY DETECTED CANCER

The management of patients with mammographic abnormalities is rapidly shifting from needle-localized surgical biopsy (NLB) to stereotactic c ore biopsy (SCB). The precise role of SCE in the management of nonpalp able breast cancer remains to be defined. The purpose of this study wa s to compare SCB to NLB in the diagnosis of mammographically detected breast cancer in women who underwent breast-conserving surgery, The re cords of all patients with nonpalpable breast cancer who underwent bre ast-conserving surgery from 1/1/95 to 6/1/97 were analyzed with respec t to method of diagnosis, time interval from detection to diagnosis an d breast-conserving surgery, volume of breast tissue excised, margin s tatus and reexcision rate, number of surgical procedures, and total ch arges and costs per patient. During a 30-month period, 117 patients wi th nonpalpable breast cancer underwent breast-conserving surgery. The diagnosis was made by NLB in 69 patients and SCB in 48 patients. The t ime from detection to diagnosis and breast-conserving surgery was 1.7 +/- 0.5 and 8.1 +/- 1.2 days for SCE patients and 6.8 +/- 1.3 and 16.9 +/- 2.3 days for NLB patients (P < 0.01). The volume of breast tissue removed was 117.9 +/- 5.6 cm(3) for SCB patients versus 75.2 +/- 2.9 cm(3) for NLB patients (P < 0.01). Three SCB patients (6%) had positiv e margins, while 38 NLB patients (55%) had positive margins (P < 0.01) . Only 1 SCB patient (2%) was reexcised, while 34 NLB patients (50%) w ere reexcised (P < 0.01). Eighty-nine percent of SCB patients had a si ngle surgical procedure compared to 39% of NLB patients (P < 0.001). P atients who underwent SCB had reduced total charges and total costs pe r patient compared to NLB patients ($11,700 +/- $554 and $3537 +/- $16 7 per SCB patient versus $15,654 +/- $706 and $4853 +/- $198 per NLB p atient, P < 0.0001). Stereotactic core biopsy shortens the time from d etection at mammography to diagnosis and breast-conserving therapy, pe rmits appropriate discussion of treatment alternatives, reduces the po sitive margin rate and reexcision rate, and may represent a significan t cost savings in the management of nonpalpable breast cancer. (C) 199 8 Academic Press.