SURVEILLANCE MAMMOGRAPHY AND STEREOTAXIC CORE BREAST BIOPSY FOR PROBABLY BENIGN LESIONS - A COST COMPARISON ANALYSIS

Rationale and objectives. The authors compared the economic effect of stereotactic core needle biopsy (CNB) with that of short-term unilater al surveillance mammography in the management of probably benign breas t lesions detected during routine screening mammography. Methods. Publ ished data with regard to the cost of stereotactic CNB and unilateral mammography were applied to 3,184 patients who underwent surveillance mammography, including 161 patients who underwent biopsy. Costs of imm ediate tissue diagnosis were compared with costs of surveillance with use of ratios of published reimbursement scales to minimize geographic variations. Sensitivity analyses were applied to this ratio. Results. The cost of managing probably benign breast lesions with surveillance mammography was $3,307,575 less than if all lesions had been managed with CNB. The ratio of the cost of CNB to the cost of surveillance mam mography was 8:1. This ratio is more sensitive to the frequency of use of CNB than to reimbursement schedules. Conclusion. With similar fals e-negative rates, CNB is more costly than surveillance and has a negat ive effect in the management of probably benign breast lesions, unless interval change during surveillance prompts tissue diagnosis.