A new study confirms that a less invasive form of breast biopsy called the vacuum-assisted biopsy (brand names, Mammotome or MIBB) costs significantly less than the standard open surgical biopsy method. During a breast biopsy, samples of tissue are taken from the breast to confirm or deny the presence of cancer. It is estimated that approximately 800,000 breast biopsies are performed each year in the United States, although only around 20% of women who undergo biopsy procedures are diagnosed with breast cancer. The study shows that the average cost of a vacuum-assisted biopsy is 35% to 62% less than the cost of a surgical biopsy, depending on the type of facility where the biopsy is performed.
Vacuum-assisted biopsy is a relatively new type of percutaneous ("through the skin") breast biopsy procedure that removes significantly less tissue than the standard open surgical biopsy and offers other benefits as well (see chart below). This type of biopsy may be appropriate for many women whose breast abnormalities are detected by mammogram or for those with small breast lumps. Two companies currently manufacture vacuum-assisted biopsy systems, and often, vacuum-assisted biopsy is referred to by the brand name: either Mammotome made by Johnson & Johnson Ethicon Endo-Surgery or MIBB (which stands for Minimally Invasive Breast Biopsy) made by Tyco/United States Surgical Corporation. Ethicon Endo Surgery funded the study that examined the cost of vacuum-assisted breast biopsy versus open surgical breast biopsy.
To conduct the study, Balazs Bodai, MD, chief of surgery for Kaiser Permanente Medical Center in Sacramento, California, and his colleagues compared the costs of 71 open surgical breast biopsies and 96 vacuum-assisted breast biopsies on women who had non-palpable breast abnormalities (breast abnormalities that could not be felt by hand). The researchers discovered that the total cost of the two procedures tend to vary significantly depending on where they are performed.
For example, the study found that a vacuum-assisted breast biopsy is approximately $505.50 less (37% less) than an open surgical breast biopsy when performed in a hospital. Similarly, a vacuum-assisted biopsy is approximately $405.73 less (35% less) than an open surgical biopsy when performed at a surgical center. Of course, the greatest cost difference was seen when the researchers compared the cost of a vacuum-assisted biopsy performed at an imaging center versus an open surgical biopsy performed at a hospital. Then, the cost of the vacuum-assisted biopsy was approximately 62% less than the open surgical biopsy. The estimated cost of an open surgical biopsy can be up to $5000 including surgeon fees.
The vacuum-assisted breast biopsy method is considered a reliable alternative to the traditional open surgical biopsy method in many cases. The vacuum-assisted biopsy procedure involves only one needle insertion into the breast but allows several breast tissue samples to be taken during this time. In this way, it differs from another percutaneous ("through the skin") biopsy method, the core needle biopsy, which requires multiple needle sticks to obtain multiple breast tissues samples.
Though vacuum-assisted biopsy is becoming more common, it requires the skill of a highly trained radiologist or surgeon who is experienced in performing the procedure. Some patients are not good candidates for vacuum-assisted biopsy or may have breast abnormalities that are difficult to locate with minimally-invasive equipment. Therefore, patients should discuss breast biopsy options with their physicians to determine which method is most appropriate given their individual medical circumstances.
Traditional open surgical biopsy is the gold standard to which other methods of breast biopsies are compared. Until about a decade ago, most breast biopsies were open surgical procedures. Surgical biopsy yields the largest breast tissue sample of all the breast biopsy methods, making the accuracy of a diagnosis using the open surgical method close to 100%. However, open surgery biopsy does have disadvantages, especially if the breast abnormality turns out to be non-cancerous:
- Open surgical biopsy requires stitches and can leave a scar
- Scar formation within the breast may persist for 12 months or longer with open surgical biopsy and may complicate the interpretation of follow-up mammograms
For women who are candidates for the less invasive vacuum-assisted biopsy method (Mammotome or MIBB), the procedure can offer several advantages over the traditional open surgical breast biopsy:
| Vacuum-Assisted Biopsy | Open Surgical Biopsy |
| Minimally invasive, requires 0.25 inch incision (approximately 0.6 cm) | Requires 1.5 to 2 inch incision (approximately 3.8 cm to 5.1 cm) |
| Usually no significant scarring | May potentially cause substantial scarring |
| Performed under local anesthesia | Performed under local or general anesthesia |
| Does not require stitches | Requires stitches |
| Procedure takes less than one hour | Procedure takes longer than one hour |
| Patients can usually return to normal activity shortly after procedure | Requires at least one full day of recovery after the procedure |
| Typically costs significantly less than open surgical biopsy | Typically costs more than vacuum-assisted biopsy and is usually the most expensive method of biopsy |
| Usually provides a definitive diagnosis based on tissue samples | Provides a definitive diagnosis based on tissue samples |
- The study, "Total Cost Comparison of 2 Biopsy Methods for Nonpalpable Breast Lesions," is published in the May 2001 issue of The American Journal of Managed Care, http://www.ajmc.com
- The May 21, 2001 Ethicon Endo-Surgery press release is entitled, "Study Finds Minimally Invasive Breast Biopsies Cost 35%-62% Less Overall Than Open Surgical Biopsies," http://www.ethiconendosurgery.com/
- To learn more about breast biopsy, including the different types of procedures, please visit http://www.imaginis.com/breasthealth/biopsy/
