Comparative cost‐effectiveness of fine needle aspiration biopsy versus image‐guided biopsy, and open surgical biopsy in the evaluation of breast cancer in the era of affordable care act: A changing landscape

Masood, Shahla; Rosa, Marilin; Kraemer, Dale F.; Smotherman, Carmen; Mohammadi, Amir

doi:10.1002/dc.23270

Cited by 20 publications

(20 citation statements)

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“…CNB offers advantages in definitively diagnosing invasive carcinoma, assessing mammographically detected calcifications and assisting with proliferative lesions, but similarly to FNAB, it is a sampling device. CNB is more invasive, time consuming, has a higher rate of complications, and has a greater cost for both the biopsy equipment and the required histopathological laboratory processing and reporting [16, 21, 22]. There are reports of a risk of track seeding by carcinoma [23], and of a possible worse prognosis after CNB [24].…”

Section: Introductionmentioning

confidence: 99%

The International Academy of Cytology Yokohama System for Reporting Breast Fine-Needle Aspiration Biopsy Cytopathology

et al. 2019

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The International Academy of Cytology (IAC) gathered together a group of cytopathologists expert in breast cytology who, working with clinicians expert in breast diagnostics and management, have developed the IAC Yokohama System for Reporting Breast Fine-Needle Aspiration Biopsy (FNAB) Cytology. The project was initiated with the first cytopathology group meeting in Yokohama at the 2016 International Congress of Cytology. This IAC Yokohama System defines five categories for reporting breast cytology, each with a clear descriptive term for the category, a definition, a risk of malignancy (ROM) and a suggested management algorithm. The key diagnostic cytopathology features of each of the lesions within each category will be presented more fully in a subsequent atlas. The System emphasizes that the crucial requirements for diagnostic breast FNAB cytology are a high standard for the performance of the FNAB and for the making of direct smears, and well-trained experienced cytopathologists to interpret the material. The performance indicators of breast FNAB, including specificity and sensitivity, negative predictive value, positive predictive value and ROM stated in this article have been derived from the recent literature. The current practice of breast FNAB has evolved with the increasing use of ultrasound guidance and rapid on-site evaluation. Two recent publications have shown a range of ROM for the insufficient/inadequate category of 2.6–4.8%, benign 1.4–2.3%, atypical 13–15.7%, suspicious of malignancy 84.6–97.1%, and malignant 99.0–100%. The management algorithm in the System provides options because there are variations in the management of breast lesions using FNAB and core-needle biopsy in those countries utilizing the “triple test” of clinical, imaging, and FNAB assessment, and also variations in the availability of CNB and imaging in low- and middle-income countries. The System will stimulate further discussion and research, particularly in the cytological diagnostic features of specific lesions within each category and in management recommendations. This will lead to continuing improvements in the care of patients with breast lesions and possible modifications to the IAC Yokohama System.

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Section: Introductionmentioning

confidence: 99%

The International Academy of Cytology Yokohama System for Reporting Breast Fine-Needle Aspiration Biopsy Cytopathology

et al. 2019

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“…Therefore, our negative predictive value needs to be considered in that context, as we are uncertain of the outcomes in those for whom we lost contact. Poor compliance has been demonstrated consistently in the literature and remains a significant problem. Any patient unable or unwilling to undergo periodic follow‐up evaluation is not an appropriate candidate for surveillance and should undergo immediate biopsy.…”

Section: Discussionmentioning

confidence: 73%

“…Another cost‐effective method of addressing probably benign masses is fine needle aspiration biopsy (FNAB) . According to 2017 published Medicare reimbursement rates, image‐guided breast FNAB would cost $299.31 (codes 10022 and 88173).…”

Section: Discussionmentioning

confidence: 99%

Palpable breast abnormalities in women under age 40

Lee

Shaw²,

Chi

et al. 2018

Breast J

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Although the prevalence of malignancy in average risk women under age 40 presenting with a palpable breast abnormality is low, the management of benign‐appearing palpable abnormalities remains controversial. This study assesses the imaging evaluation, subsequent management, and outcomes of women under age 40 presenting with a palpable area of concern. This study also evaluates the costs, utility, and outcomes of BI‐RADS 3 assessment in this patient population. A single institution retrospective case review from July 2010 through June 2013 identified women under age 40 presenting with a new palpable breast abnormality. Diagnostic imaging evaluation was performed. BI‐RADS assessments and recommendations were recorded prospectively. Outcome was determined by tissue diagnosis, 2 years of surveillance, or search of the hospital tumor registry. Performance measures were calculated. Among 1440 cases, 1052 were initially assessed as BI‐RADS 1 or 2 (73.1%), 184 as BI‐RADS 3 (12.8%), 182 as BI‐RADS 4 (12.6%), and 22 as BI‐RADS 5 (1.5%). In all, 30 breast malignancies were diagnosed (cancer yield 2.1%). All 30 cancers were initially categorized as BI‐RADS 4 or 5. No BI‐RADS 1, 2, or 3 findings proved malignant. The imaging evaluation sensitivity was 100%, specificity was 87.7%, and accuracy was 87.9%. The negative predictive value was 100% and the positive predictive value was 14.7%. Average risk women under age 40 presenting with a palpable abnormality have a low prevalence of breast cancer. Imaging evaluation has a high sensitivity and negative predictive value, thereby allowing for confident characterization and appropriate management recommendations. For palpable solid masses with benign imaging features in women under age 40, short‐term interval follow‐up with subsequent periodic imaging or clinical examination for a total of 2 years is a cost‐effective and safe alternative to biopsy.

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“…59 In a recent comprehensive cost analysis of cancer detection in breast lesions, Masood et al demonstrated that the total cost to the patient (median biopsy cost and total hospital/pathology charges) for a palpable FNA ($522.64) was less than that for ultrasound-guided FNA ($3818.00) or for imageguided CNB ($5946.00), interestingly with somewhat comparable cancer detection rates across the procedures. 60 These relative costs appear to hold true in other organ systems as well. In a 2015 study of palpable neck nodules, Ryu et al quoted a cost of $19.90 for FNA, $243.10 for ultrasound-guided FNA, and $274.60 for ultrasoundguided CNB.…”

Section: Cost Considerations Of Fna and Cnbmentioning

confidence: 96%

“…An older 2008 study from Finland demonstrated that for breast lesions, palpable FNA cost less than palpable CNB (€36.51 vs €70.02), ultrasound‐guided FNA cost less than ultrasound‐guided CNB (€44.65 vs €82.94), and all were much less expensive than stereotactic‐guided CNB (€246.37) . In a recent comprehensive cost analysis of cancer detection in breast lesions, Masood et al demonstrated that the total cost to the patient (median biopsy cost and total hospital/pathology charges) for a palpable FNA ($522.64) was less than that for ultrasound‐guided FNA ($3818.00) or for image‐guided CNB ($5946.00), interestingly with somewhat comparable cancer detection rates across the procedures . These relative costs appear to hold true in other organ systems as well.…”

Section: Introductionmentioning

confidence: 99%

Fine‐needle aspiration and core needle biopsy: An update on 2 common minimally invasive tissue sampling modalities

VanderLaan

2016

Cancer Cytopathology

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Fine-needle aspiration (FNA) and core needle biopsy (CNB) represent 2 of the most common minimally invasive tissue sampling modalities. Although similar in many ways, there are significant differences in the collection, processing, interpretation, and suitability for ancillary testing that exist between FNA and CNB. This review provides a brief overview of the strengths and weaknesses of FNA compared with CNB, as well as an update regarding the landscape of recently published studies that investigate the organ-specific comparative performance metrics of FNA and CNB. A current understanding of the benefits and limitations of FNA and CNB will help the cytopathologist and the clinician alike to select the right procedure for the right patient at the right time. Cancer Cytopathol 2016;124:862-870. © 2016 American Cancer Society.

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Comparative cost‐effectiveness of fine needle aspiration biopsy versus image‐guided biopsy, and open surgical biopsy in the evaluation of breast cancer in the era of affordable care act: A changing landscape

Abstract: This study confirms the comparative effectiveness of FNAB in the evaluation of patients with breast cancer and justifies serious endorsement of this procedure as the initial diagnostic sampling modality for its unique potential in rapid reporting and cost-saving.

Cited by 20 publications

References 50 publications

The International Academy of Cytology Yokohama System for Reporting Breast Fine-Needle Aspiration Biopsy Cytopathology

The International Academy of Cytology Yokohama System for Reporting Breast Fine-Needle Aspiration Biopsy Cytopathology

Palpable breast abnormalities in women under age 40

Fine‐needle aspiration and core needle biopsy: An update on 2 common minimally invasive tissue sampling modalities

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