Liberman L, Feng T L, Dershaw D D, Morris E A, Abramson A F
Breast Imaging Section, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Radiology. 1998 Sep;208(3):717-23. doi: 10.1148/radiology.208.3.9722851.
To determine the frequency with which ultrasonographically (US) guided core biopsy obviated diagnostic surgical biopsy of nonpalpable breast masses, to calculate the cost savings of diagnosis attributable to US-guided core biopsy, and to compare the costs of US-guided versus stereotactically guided core biopsy.
US-guided core biopsy was performed in 151 consecutive solitary, nonpalpable breast masses in 151 women (age range, 23-80 years) by using a 14-gauge automated gun and needle. Clinical follow-up data were obtained. Cost savings were assessed by using national Medicare reimbursement costs of +385 for US-guided core biopsy, +610 for stereotactic core biopsy, and +1,332 for needle localization and surgical biopsy.
US-guided core biopsy obviated a surgical procedure in 128 (85%) of 151 women. The mean adjusted direct cost saving per US-guided core biopsy was +744 per case. Use of US-guided biopsy decreased the cost of diagnosis by 56% (+744/+1,332) over the cost of surgical biopsy. If biopsy had been performed with stereotactic rather than with US guidance, the mean adjusted direct cost saving would have been +519 per case, a 39% (+519/1,332) decrease in the cost of diagnosis compared with the cost of surgical biopsy.
Percutaneous biopsy of a nonpalpable breast mass with either US or stereotactic guidance is less expensive than surgery, but cost savings are greater with US-guided biopsy.
确定超声（US）引导下的粗针活检避免不可触及乳腺肿块诊断性手术活检的频率，计算因US引导下粗针活检导致的诊断成本节约，并比较US引导与立体定位引导下粗针活检的成本。
使用14号自动活检枪和针，对151名女性（年龄范围23 - 80岁）的151个连续的孤立性、不可触及乳腺肿块进行US引导下粗针活检。获取临床随访数据。通过使用美国医疗保险报销费用评估成本节约情况，US引导下粗针活检为385美元，立体定位粗针活检为610美元，针定位及手术活检为1332美元。
在151名女性中，128名（85%）通过US引导下粗针活检避免了手术。每例US引导下粗针活检的平均调整后直接成本节约为744美元。与手术活检成本相比，使用US引导活检使诊断成本降低了56%（744美元/1332美元）。如果活检采用立体定位而非US引导，平均调整后直接成本节约将为每例519美元，与手术活检成本相比，诊断成本降低39%（519美元/1332美元）。
对于不可触及的乳腺肿块，经皮US或立体定位引导下活检比手术成本低，但US引导下活检成本节约更多。
