Masood Shahla, Rosa Marilin, Kraemer Dale F, Smotherman Carmen, Mohammadi Amir
Department of Pathology and Laboratory Medicine, University of Florida, Jacksonville, Florida.
Center for Health Equity and Quality Research, University of Florida, Jacksonville, Florida.
Diagn Cytopathol. 2015 Aug;43(8):605-12. doi: 10.1002/dc.23270. Epub 2015 Feb 26.
Proven as a time challenged and cost-effective sampling procedure, the use of FNAB has still remained controversial among the scientific community. Currently, other minimally invasive sampling procedures such as ultrasound guided fine needle aspiration biopsy (US-FNAB) and image guided core needle biopsy (IG-CNB) have become the preferred sampling procedures for evaluation of breast lesions. However, changes in the medical economy and the current growing emphasis on cost containment in the era of the Affordable Care Act make it necessary to stimulate a renewed interest in the use of FNAB as the initial diagnostic sampling procedure. This study was designed to define the changing trend in the practice of tissue sampling during the last several years, and to assess the comparative effectiveness and appropriateness of the procedure of choice for breast cancer diagnosis.
After Institutional Review Board (IRB) approval, the computer database of the Pathology Department, University of Florida, College of Medicine-Jacksonville at UF Health was retrospectively searched to identify all breast biopsy pathology reports issued during the period of January 2004 to December 2011. The inclusion criteria were all women that underwent any of the following biopsy types: FNAB, US-FNAB, IG-CNB, and surgical biopsy (SB). Diagnostic procedures were identified using current procedural terminology (CPT) codes recorded on claims from the UF Health Jacksonville patient accounting application files. The data obtained was used to determine which technique has the best cost-effectiveness in the diagnosis of breast cancer. The outcome variable for this project was a positive breast cancer diagnosis resulting from these methodologies. The predictor variable was the biopsy type used for sampling. The rate of cancer detection for each procedure was also determined.
Among the four groups of procedures compared, the lower cost was attributed to FNAB, followed by US-FNAB, and SB. IG-CNB was the most costly procedure, even more expensive than SB. The more costs associated with IG-CNB compared to SB is related to the expense involved in the use of localizing devices and also attempts to sample a lesion more than once. More importantly, cancer yield by FNAB was the highest among all the procedures under study.
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.
细针穿刺抽吸活检（FNAB）虽被证明是一种节省时间且具成本效益的采样方法，但在科学界仍存在争议。目前，其他微创采样方法，如超声引导下细针穿刺抽吸活检（US-FNAB）和影像引导下粗针穿刺活检（IG-CNB），已成为评估乳腺病变的首选采样方法。然而，医疗经济的变化以及《平价医疗法案》时代对成本控制的日益重视，使得有必要重新激发对将FNAB用作初始诊断采样方法的兴趣。本研究旨在确定过去几年组织采样实践中的变化趋势，并评估乳腺癌诊断所选方法的相对有效性和适宜性。
经机构审查委员会（IRB）批准后，对佛罗里达大学医学院杰克逊维尔分校UF Health病理科的计算机数据库进行回顾性检索，以识别2004年1月至2011年12月期间发布的所有乳腺活检病理报告。纳入标准为所有接受以下任何一种活检类型的女性：FNAB、US-FNAB、IG-CNB和手术活检（SB）。使用UF Health杰克逊维尔患者计费应用文件中索赔记录的当前程序术语（CPT）代码识别诊断程序。所获得的数据用于确定哪种技术在乳腺癌诊断中具有最佳成本效益。该项目的结果变量是由这些方法导致的乳腺癌阳性诊断。预测变量是用于采样的活检类型。还确定了每种程序的癌症检测率。
在比较的四组程序中，成本较低的是FNAB，其次是US-FNAB和SB。IG-CNB是最昂贵的程序，甚至比SB还贵。与SB相比，IG-CNB相关的成本更高，这与使用定位设备的费用以及对病变进行多次采样的尝试有关。更重要的是，在所有研究的程序中，FNAB的癌症检出率最高。
本研究证实了FNAB在评估乳腺癌患者方面的相对有效性，并证明了该程序因其在快速报告和节省成本方面的独特潜力而作为初始诊断采样方式得到认真认可的合理性。
