Howisey R L, Acheson M B, Rowbotham R K, Morgan A
Seattle Breast Center Multidisciplinary Team at Northwest Hospital, Washington 98133, USA.
Am J Surg. 1997 May;173(5):395-8. doi: 10.1016/S0002-9610(97)00071-8.
The Medicare population makes up a large proportion of the patients who undergo evaluation and treatment of mammographically detected breast lesions. In the past, the standard approach for obtaining a histological specimen for definitive diagnosis has been wire localization followed by open surgical excision (WL-OSE). In recent years, however, imaging-guided large core needle biopsy (LCNB) has been investigated as a more cost effective and less invasive alternative.
The authors examined accuracy and reimbursement of ultrasound-guided LCNB, stereotactic-guided LCNB, and WL-OSE in 139 Medicare patients who demonstrated abnormalities on screening mammograms in 1994 and 1995.
Ultrasound-guided LCNB was used to diagnose 20% of these cases, sterotactic LCNB was used to diagnose 68% of the cases, and the remaining 12% were diagnosed using WL-OSE. Histological diagnoses for 54 LCNBs (20 ultrasound-guided and 34 stereotactic-guided) were 98% accurate when compared with a subsequent surgical excision specimen. Ultrasound-guided LCNB was the most cost-effective approach, showing an average savings of $1,960 per procedure over WL-OSE and $211 over stereotactic-guided LCNB. Stereotactic-guided LCNB was significantly more cost effective than WL-OSE, showing an average savings of $1,750 per procedure.
These data indicate imaging-guided LCNB to be a reasonable alternative to WL-OSE for definitive histological diagnosis of nonpalpable breast lesions. Ultrasound-guided imaging was shown to be applicable in 20% of the cases and is the least expensive to the Medicare system. The stereotactic approach can be used for a much larger percentage of these patients and although not as cost effective as ultrasound, it is considerably more cost effective than open excisional biopsy. Both core biopsy techniques provided accurate histological diagnoses.
医疗保险人群占接受乳腺钼靶检测出的乳腺病变评估和治疗患者的很大比例。过去，获取用于明确诊断的组织学标本的标准方法是钢丝定位后开放手术切除（WL - OSE）。然而近年来，影像引导下的粗针活检（LCNB）作为一种更具成本效益且侵入性较小的替代方法受到了研究。
作者对1994年和1995年乳腺钼靶筛查显示异常的139名医疗保险患者，检查了超声引导下LCNB、立体定向引导下LCNB和WL - OSE的准确性及费用报销情况。
超声引导下LCNB用于诊断其中20%的病例，立体定向LCNB用于诊断68%的病例，其余12%采用WL - OSE诊断。与后续手术切除标本相比，54例LCNB（20例超声引导和34例立体定向引导）的组织学诊断准确率为98%。超声引导下LCNB是最具成本效益的方法，与WL - OSE相比，每次操作平均节省1960美元，与立体定向引导下LCNB相比节省211美元。立体定向引导下LCNB比WL - OSE成本效益显著更高，每次操作平均节省1750美元。
这些数据表明，影像引导下LCNB是对不可触及乳腺病变进行明确组织学诊断的WL - OSE的合理替代方法。超声引导成像适用于20%的病例，对医疗保险系统来说成本最低。立体定向方法可用于更大比例的这些患者，虽然不如超声成本效益高，但比开放切除活检成本效益高得多。两种粗针活检技术都提供了准确的组织学诊断。
