Office based wire-guided open breast biopsy under local anesthesia is accurate and cost effective

BACKGROUND: Mammographic abnormalities found to be malignant by stereotacti c biopsy still require a wire-guided biopsy (WGB) in most cases. We have pr eviously described a simplified method of WGB that allows the procedure to be done with a minimum of dissection and under local anesthesia in the offi ce setting. We hypothesized that this procedure can be used to produce cost -effective, office-based breast preservation therapy (BPT). METHODS: We reviewed our recent experience with this WGB method to determin e applicability and accuracy in the office setting. A cost-effectiveness an alysis was also performed to determine potential charge reductions when thi s method is used to avoid operating room (OR) usage for either lumpectomy o r lumpectomy plus sentinel lymph node biopsy (SLNB). RESULTS: Of the 164 biopsies reviewed, 114 (70%) were performed in the offi ce setting under local anesthesia and 50 (30%) were performed in the OR. Th e most common reasons for choosing the OR setting included performance of b iopsy during an unrelated procedure requiring the OR (16 cases), patient pr eference (12), deep lesions (6), and the inability of the patient to cooper ate with local anesthesia (5). The complication rates were similar between the two settings (7% for office-based and 4% for OR; P = 0.697), and in nei ther setting were any lesions missed. A cost-effectiveness analysis using o ur Current Procedure Terminology (CPT)-based charges revealed a potential p er-case charge reduction of $4,632 for office-based lumpectomy and $4306 fo r office-based lumpectomy/SLNB, using our method of WGB and local anesthesi a, compared with the OR setting. CONCLUSIONS: Office-based WGB using our previously described method is accu rate and can be applied to at least 70% of patients. Based on the favorable results of our cost analysis and rising support for SLNB, we anticipate in creased utilization of the clinic setting and local anesthesia for BPT in t he future, (C) 2000 by Excerpta Medica, Inc.