Calcifications highly suggestive of malignancy: Comparison of breast biopsy methods

Objective. The purpose of this study was to compare the usefulness of, and cost of diagnosing with, different breast biopsy methods for women with cal cifications highly suggestive of malignancy. Materials and methods. One hundred thirty-nine women with calcifications hi ghly suggestive of malignancy underwent diagnostic biopsy. Of these, 89 wom en had stereotactic biopsy with a 14-gauge automated needle (n = 25), 14-ga uge vacuum-assisted probe (n = 17), or 11-gauge vacuum-assisted probe (n = 47); and 50 women had diagnostic surgical biopsy. Medical records were revi ewed. Cost savings for stereotactic biopsy were calculated using Medicare d ata. Results. The median number of operations was one for women who had stereota ctic biopsy versus two for women who had diagnostic surgical biopsy. The li kelihood of undergoing a single operation was significantly greater for wom en who had stereotactic rather than surgical biopsy, among all women (61/89 [68.5%] vs. 19/50 [38.0%],p < 0.001) and among women treated for breast ca ncer (55/77 [71.4%] vs. 6/37 [16.2%], p = 0.0000001). Stereotactic Ii-gauge vac uum-assisted biopsy, as compared with 14-gauge automated core or 14-ga uge vacuum-assisted biopsy, was significantly more Likely to spare a surgic al procedure (36/47 [76.6%] vs. 16/42 [38.1%], p = 0.0005). Stereotactic 11 -gauge vacuum-assisted biopsy resulted in the greatest cost reduction, yiel ding savings of $315 per case compared with diagnostic surgical biopsy; for women with solitary lesions, stereotactic 11-gauge biopsy decreased the co st of diagnosis by 22.2% ($334/$1502). Conclusion. For women with calcifications highly suggestive of malignancy, the use of stereotactic rather than surgical biopsy decreases the number of operations. Stereotactic 11-gauge vacuum-assisted biopsy, as compared with 14-gauge automated core or 14-gauge vacuum-assisted biopsy, is significant ly more likely to spare a surgical procedure and has the highest cost savin gs.