Large-core needle biopsy versus fine-needle aspiration biopsy in solid breast lesions: comparison of costs and diagnostic value

Abstract

Background: In the current climate of budget constraints and personnel shortages, hospitals are required to demonstrate ever-greater cost effectiveness. In the diagnosis of breast lesions, it is useful to compare the costs and benefits of fine-needle aspiration biopsy (FNAB) and core-needle biopsy (CNB). Purpose: To determine the total costs of FNAB and CNB of breast lesions, and to compare the costs and diagnostic value of these methods. Material and Methods: The material consisted of 688 breast lesion cases from a Finnish breast-imaging unit. All cases underwent FNAB and/or CNB. Based on the primary biopsy method used, the cases were allocated to the FNAB ( n=590) or CNB ( n=98) group. Data on costs, sensitivity, and specificity were used to compare the cost effectiveness of the two methods. Results: 590 FNABs were performed in the FNAB group and 98 CNBs in the CNB group. In addition, we needed 78 CNBs in the FNAB group and 11 FNABs in the CNB group for further assessment. The false-negative rate for FNAB was 19% and for CNB 11%; the false-positive rates were 9% and 1%, respectively. The average cost of biopsies per case in the FNAB group was €66 and in the CNB group €221. FNAB was most expensive when performed under ultrasound guidance (€44.65) and CNB when performed under stereotactic guidance (€246.37). Conclusion: FNAB is a less reliable and less informative diagnostic method than CNB. Although a negative or indeterminate FNAB result requires follow-up or a re-biopsy with core needle, it is still a cost-effective procedure. Stereotactic guidance considerably increases the costs of CNB, and therefore US guidance should be used whenever possible.