Document Detail

Office-based wire-guided open breast biopsy under local anesthesia is accurate and cost effective.
MedLine Citation:
PMID:  10930494     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Mammographic abnormalities found to be malignant by stereotactic biopsy still require a wire-guided biopsy (WGB) in most cases. We have previously described a simplified method of WGB that allows the procedure to be done with a minimum of dissection and under local anesthesia in the office setting. We hypothesized that this procedure can be used to produce cost-effective, office-based breast preservation therapy (BPT). METHODS: We reviewed our recent experience with this WGB method to determine applicability and accuracy in the office setting. A cost-effectiveness analysis was also performed to determine potential charge reductions when this method is used to avoid operating room (OR) usage for either lumpectomy or lumpectomy plus sentinel lymph node biopsy (SLNB). RESULTS: Of the 164 biopsies reviewed, 114 (70%) were performed in the office setting under local anesthesia and 50 (30%) were performed in the OR. The most common reasons for choosing the OR setting included performance of biopsy during an unrelated procedure requiring the OR (16 cases), patient preference (12), deep lesions (6), and the inability of the patient to cooperate with local anesthesia (5). The complication rates were similar between the two settings (7% for office-based and 4% for OR; P = 0.697), and in neither setting were any lesions missed. A cost-effectiveness analysis using our Current Procedure Terminology (CPT)-based charges revealed a potential per-case charge reduction of $4,632 for office-based lumpectomy and $4306 for office-based lumpectomy/SLNB, using our method of WGB and local anesthesia, compared with the OR setting. CONCLUSIONS: Office-based WGB using our previously described method is accurate and can be applied to at least 70% of patients. Based on the favorable results of our cost analysis and rising support for SLNB, we anticipate increased utilization of the clinic setting and local anesthesia for BPT in the future.
K T Morris; R F Pommier; J T Vetto
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  American journal of surgery     Volume:  179     ISSN:  0002-9610     ISO Abbreviation:  Am. J. Surg.     Publication Date:  2000 May 
Date Detail:
Created Date:  2000-09-06     Completed Date:  2000-09-06     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0370473     Medline TA:  Am J Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  422-5     Citation Subset:  AIM; IM    
Department of Surgery, Section of Surgical Oncology, Oregon Health Sciences University, Portland, Oregon 97201-3098, USA.
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MeSH Terms
Aged, 80 and over
Anesthesia, Local / adverse effects,  economics*,  methods*
Biopsy / adverse effects,  economics*,  methods*
Breast Neoplasms / pathology*,  radiography
Cost-Benefit Analysis
Feasibility Studies
Mammography / adverse effects,  economics*,  methods*
Mastectomy, Segmental / adverse effects,  economics*,  methods*
Middle Aged
Office Visits* / economics
Operating Rooms / economics
Patient Selection
Radiography, Interventional / adverse effects,  economics*,  methods*
Reproducibility of Results
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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