Nervil G G, Vestergaard T, Klausen S, Tolsgaard M G, Ternov N K, Hölmich L R
Department of Plastic Surgery, Copenhagen University Hospital - Herlev and Gentofte, Denmark.
Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark.
J Eur Acad Dermatol Venereol. 2025 Jul;39(7):1267-1277. doi: 10.1111/jdv.20371. Epub 2024 Oct 12.
Due to a multitude of factors, skin cancer incidence is increasing and challenges medical professionals in biopsy decision-making. While skin cancer may have a profound impact on the patient and be costly for society, there is little knowledge about the number and cost of benign skin lesions biopsied as collateral damage.
This study evaluates the number and costs of skin biopsies in Denmark over 15 years, focusing on benign and malignant skin lesions and melanomas across medical settings. It aims to determine the benign to malignant ratio (BMR) and number needed to biopsy (NNB) and estimate the direct cost of benign skin lesion biopsies in the Cancer Pathway from the perspective of a public healthcare system.
The study included 4,481,207 biopsy specimens from January 2007 to June 2022 from the Danish Pathology Data Bank, of which 151,988 from the Cancer Pathway were included in the primary analysis of BMR. The national reimbursement rates for biopsies were used, alongside histopathological examination costs extracted from several pathology departments, for a Monte-Carlo simulation of a simple cost and sensitivity analysis.
The number of biopsies increased by 39.1% from 2007 to 2021. Overall BMR for malignancy was 4.1:1, and NNB for melanoma was 31.8, but biopsies performed on clinical suspicion of malignancy or melanoma had a BMR and NNB of 1.5:1 and 2.8, respectively. The cost of benign skin biopsies performed on suspicion of cancer or melanoma in 2021 was €6.6M, predominantly in hospitals.
A healthcare system that employs filtering functions before biopsy of skin lesions can achieve some of the lowest BMR reported in the world, but with most benign skin lesion excisions due to suspicion of malignancy performed in the expensive hospital setting. Including clinical reason for biopsy in diagnostic accuracy studies using NNB is crucial.
由于多种因素，皮肤癌发病率不断上升，这给医学专业人员在活检决策方面带来了挑战。虽然皮肤癌可能对患者产生深远影响且给社会带来高昂成本，但对于作为附带损害而进行活检的良性皮肤病变的数量和成本却知之甚少。
本研究评估丹麦15年间皮肤活检的数量和成本，重点关注不同医疗环境下的良性和恶性皮肤病变及黑色素瘤。旨在确定良性与恶性比例（BMR）和活检所需数量（NNB），并从公共医疗系统的角度估算癌症诊疗路径中良性皮肤病变活检的直接成本。
该研究纳入了丹麦病理数据库2007年1月至2022年6月的4481207份活检标本，其中癌症诊疗路径中的151988份标本被纳入BMR的初步分析。使用活检的国家报销率以及从多个病理科提取的组织病理学检查成本，进行简单成本和敏感性分析的蒙特卡洛模拟。
2007年至2021年活检数量增加了39.1%。恶性病变的总体BMR为4.1:1，黑色素瘤的NNB为31.8，但基于临床怀疑为恶性或黑色素瘤而进行的活检，其BMR和NNB分别为1.5:1和2.8。2021年因怀疑癌症或黑色素瘤而进行的良性皮肤活检成本为660万欧元，主要发生在医院。
在皮肤病变活检前采用筛选功能的医疗系统能够实现全球报告中一些最低的BMR，但由于怀疑恶性而进行的大多数良性皮肤病变切除是在昂贵的医院环境中进行的。在使用NNB的诊断准确性研究中纳入活检的临床原因至关重要。
