User login
Open breast biopsy accounted for 34% of breast biopsies in 25,965 U.S. inpatients between 2008 and 2010, a retrospective study found.
The finding suggests that minimally invasive breast biopsy techniques are underutilized, with a national rate that’s far off the widely acknowledge goal of having at least 90% of biopsies for suspicious breast lesions be minimally invasive, Dr. Linda Adepoju reported.
Most breast biopsies are performed in outpatient settings. Although the study analyzed a national data sample for hospitalized patients, the rate of open breast biopsy is consistent with previous studies of outpatient databases for individual institutions or states that have reported rates of open breast biopsy from 24% to 36%, noted Dr. Adepoju of the University of Toledo (Ohio).
She and her associates analyzed data from 46 states in the Healthcare Cost and Utilization Project National Inpatient Sample for 2008-2010, excluding 222 cases in which an open breast biopsy and minimally invasive breast biopsy were performed during the same hospital stay.
Open breast biopsy rates were significantly higher in women aged 49 years or younger (47%), compared with older women (29%), and in Asian women (40%) or Hispanic women (41%), compared with white women (34%) or black women (31%). Open breast biopsy also was significantly more likely in women who had private insurance than in women covered by Medicaid or Medicare – 41% vs. 31% (Am. J. Surg. 2014;208:382-90).
The type and location of hospital also was associated with open biopsy rates, with higher rates in small, private, rural, and/or nonteaching hospitals.
"Interventions targeting small, rural, and nonteaching hospitals could significantly decrease hospital costs and improve the overall quality of breast care," Dr. Adepoju and her associates commented, but "we must be sensitive" to the needs and limitations of various health care delivery settings, they added.
"A critical access hospital in rural Ohio may not be able to afford a mammographer and stereotactic equipment" for minimally invasive breast biopsy. Previous data "are clear that patients preferably seek their care in and near their community. Given workforce shortages and the current economic climate, this may mean accepting higher open breast biopsy rates in rural America," the investigators concluded.
Patients who had open breast biopsies in the current study were more likely to need more than one biopsy for diagnosis (1.2%), compared with women who had minimally invasive breast biopsies (0.5%). Hematoma drainage was needed in 1.4% of patients after open breast biopsy and 0.6% after minimally invasive biopsy. Open breast biopsy also was more expensive, based on analysis of data from the University of Toledo, averaging $1,700 in Medicare reimbursement, compared with $300-$1,100 for minimally invasive breast biopsy, depending on the specific procedure, Dr. Adepoju reported.
Previous data have shown that minimally invasive breast biopsies are less expensive, less scarring, require less recovery time, cause fewer complications, reduce the time between diagnosis and definitive treatment, produce fewer positive margins, and facilitate preoperative multidisciplinary treatment planning, compared with open breast biopsies.
The report from the third international consensus conference on image-detected breast cancer in 2009 called minimally invasive breast biopsy a best practice that should be the gold standard for initial diagnosis and proposed a goal of limiting open breast biopsy to 5%-10% of cases (J. Am. Coll. Surg. 2009;209:504-20).
Dr. Adepoju reported having no financial disclosures.
On Twitter @sherryboschert
The methodology of the study makes it impossible to know the overall national rates of breast biopsy techniques because the National Inpatient Sample data that the investigators analyzed capture only inpatient procedures, while most breast biopsies are done in outpatient settings, Dr. Taylor S. Riall said in an interview.
 |
|
The study may underestimate the national rate of minimally invasive breast biopsy because of that. Regardless, the true rate is likely below national goals of 90% of breast biopsies being done using minimally invasive methods, she said.
Because the National Inpatient Sample data represent single hospital stays that cannot be linked to show multiple admissions for individuals, it’s possible that some of the 34% of patients who had open breast biopsies previously underwent failed minimally invasive breast biopsies. "If minimally invasive breast biopsy was done first, then open biopsy, this is appropriate" in cases with failed (nondiagnostic) minimally invasive biopsies, she said.
The study looked at patient and hospital factors associated with biopsy rates but not at physician factors. "While there is geographic variation in the use of minimally invasive breast biopsy, there also is significant variation across physicians and facilities. Based on data we recently reviewed, I feel that physician practice and referral patterns are a major contributor to underuse of minimally invasive breast biopsy," Dr. Riall said.
"These practice patterns may be tied to reimbursement, lack of knowledge of the guidelines, access to minimally invasive breast biopsy facilities, or referral networks. Many surgeons may work in settings where mammography and biopsy are done before they even see a patient, whereas other surgeons may see patients before diagnosis and be responsible for this decision. Targeting interventions at the hospital and physician factors that are associated with low rates of minimally invasive breast biopsy can definitely improve outcomes," she added.
Organizational networks that are associated with low rates of minimally invasive breast biopsy should be assessed to find ways to increase those rates, Dr. Riall suggested. "Who do these patients see first? Do groups of physicians who refer to each other have practice patterns that violate the current recommendations?"
More in-depth analysis of racial disparities also is in order, she said. "Are these patients choosing open biopsy? If so, why? Or, alternatively, are they seeing physicians that exclusively or mostly do open biopsy? The answers to these questions will guide interventions to improve minimally invasive breast biopsy rates."
Dr. Taylor S. Riall is a professor of surgery and the John Sealy Distinguished Chair in Clinical Research at the University of Texas, Galveston. She reported having no financial disclosures.
The methodology of the study makes it impossible to know the overall national rates of breast biopsy techniques because the National Inpatient Sample data that the investigators analyzed capture only inpatient procedures, while most breast biopsies are done in outpatient settings, Dr. Taylor S. Riall said in an interview.
|
|
The study may underestimate the national rate of minimally invasive breast biopsy because of that. Regardless, the true rate is likely below national goals of 90% of breast biopsies being done using minimally invasive methods, she said.
Because the National Inpatient Sample data represent single hospital stays that cannot be linked to show multiple admissions for individuals, it’s possible that some of the 34% of patients who had open breast biopsies previously underwent failed minimally invasive breast biopsies. "If minimally invasive breast biopsy was done first, then open biopsy, this is appropriate" in cases with failed (nondiagnostic) minimally invasive biopsies, she said.
The study looked at patient and hospital factors associated with biopsy rates but not at physician factors. "While there is geographic variation in the use of minimally invasive breast biopsy, there also is significant variation across physicians and facilities. Based on data we recently reviewed, I feel that physician practice and referral patterns are a major contributor to underuse of minimally invasive breast biopsy," Dr. Riall said.
"These practice patterns may be tied to reimbursement, lack of knowledge of the guidelines, access to minimally invasive breast biopsy facilities, or referral networks. Many surgeons may work in settings where mammography and biopsy are done before they even see a patient, whereas other surgeons may see patients before diagnosis and be responsible for this decision. Targeting interventions at the hospital and physician factors that are associated with low rates of minimally invasive breast biopsy can definitely improve outcomes," she added.
Organizational networks that are associated with low rates of minimally invasive breast biopsy should be assessed to find ways to increase those rates, Dr. Riall suggested. "Who do these patients see first? Do groups of physicians who refer to each other have practice patterns that violate the current recommendations?"
More in-depth analysis of racial disparities also is in order, she said. "Are these patients choosing open biopsy? If so, why? Or, alternatively, are they seeing physicians that exclusively or mostly do open biopsy? The answers to these questions will guide interventions to improve minimally invasive breast biopsy rates."
Dr. Taylor S. Riall is a professor of surgery and the John Sealy Distinguished Chair in Clinical Research at the University of Texas, Galveston. She reported having no financial disclosures.
The methodology of the study makes it impossible to know the overall national rates of breast biopsy techniques because the National Inpatient Sample data that the investigators analyzed capture only inpatient procedures, while most breast biopsies are done in outpatient settings, Dr. Taylor S. Riall said in an interview.
|
|
The study may underestimate the national rate of minimally invasive breast biopsy because of that. Regardless, the true rate is likely below national goals of 90% of breast biopsies being done using minimally invasive methods, she said.
Because the National Inpatient Sample data represent single hospital stays that cannot be linked to show multiple admissions for individuals, it’s possible that some of the 34% of patients who had open breast biopsies previously underwent failed minimally invasive breast biopsies. "If minimally invasive breast biopsy was done first, then open biopsy, this is appropriate" in cases with failed (nondiagnostic) minimally invasive biopsies, she said.
The study looked at patient and hospital factors associated with biopsy rates but not at physician factors. "While there is geographic variation in the use of minimally invasive breast biopsy, there also is significant variation across physicians and facilities. Based on data we recently reviewed, I feel that physician practice and referral patterns are a major contributor to underuse of minimally invasive breast biopsy," Dr. Riall said.
"These practice patterns may be tied to reimbursement, lack of knowledge of the guidelines, access to minimally invasive breast biopsy facilities, or referral networks. Many surgeons may work in settings where mammography and biopsy are done before they even see a patient, whereas other surgeons may see patients before diagnosis and be responsible for this decision. Targeting interventions at the hospital and physician factors that are associated with low rates of minimally invasive breast biopsy can definitely improve outcomes," she added.
Organizational networks that are associated with low rates of minimally invasive breast biopsy should be assessed to find ways to increase those rates, Dr. Riall suggested. "Who do these patients see first? Do groups of physicians who refer to each other have practice patterns that violate the current recommendations?"
More in-depth analysis of racial disparities also is in order, she said. "Are these patients choosing open biopsy? If so, why? Or, alternatively, are they seeing physicians that exclusively or mostly do open biopsy? The answers to these questions will guide interventions to improve minimally invasive breast biopsy rates."
Dr. Taylor S. Riall is a professor of surgery and the John Sealy Distinguished Chair in Clinical Research at the University of Texas, Galveston. She reported having no financial disclosures.
Open breast biopsy accounted for 34% of breast biopsies in 25,965 U.S. inpatients between 2008 and 2010, a retrospective study found.
The finding suggests that minimally invasive breast biopsy techniques are underutilized, with a national rate that’s far off the widely acknowledge goal of having at least 90% of biopsies for suspicious breast lesions be minimally invasive, Dr. Linda Adepoju reported.
Most breast biopsies are performed in outpatient settings. Although the study analyzed a national data sample for hospitalized patients, the rate of open breast biopsy is consistent with previous studies of outpatient databases for individual institutions or states that have reported rates of open breast biopsy from 24% to 36%, noted Dr. Adepoju of the University of Toledo (Ohio).
She and her associates analyzed data from 46 states in the Healthcare Cost and Utilization Project National Inpatient Sample for 2008-2010, excluding 222 cases in which an open breast biopsy and minimally invasive breast biopsy were performed during the same hospital stay.
Open breast biopsy rates were significantly higher in women aged 49 years or younger (47%), compared with older women (29%), and in Asian women (40%) or Hispanic women (41%), compared with white women (34%) or black women (31%). Open breast biopsy also was significantly more likely in women who had private insurance than in women covered by Medicaid or Medicare – 41% vs. 31% (Am. J. Surg. 2014;208:382-90).
The type and location of hospital also was associated with open biopsy rates, with higher rates in small, private, rural, and/or nonteaching hospitals.
"Interventions targeting small, rural, and nonteaching hospitals could significantly decrease hospital costs and improve the overall quality of breast care," Dr. Adepoju and her associates commented, but "we must be sensitive" to the needs and limitations of various health care delivery settings, they added.
"A critical access hospital in rural Ohio may not be able to afford a mammographer and stereotactic equipment" for minimally invasive breast biopsy. Previous data "are clear that patients preferably seek their care in and near their community. Given workforce shortages and the current economic climate, this may mean accepting higher open breast biopsy rates in rural America," the investigators concluded.
Patients who had open breast biopsies in the current study were more likely to need more than one biopsy for diagnosis (1.2%), compared with women who had minimally invasive breast biopsies (0.5%). Hematoma drainage was needed in 1.4% of patients after open breast biopsy and 0.6% after minimally invasive biopsy. Open breast biopsy also was more expensive, based on analysis of data from the University of Toledo, averaging $1,700 in Medicare reimbursement, compared with $300-$1,100 for minimally invasive breast biopsy, depending on the specific procedure, Dr. Adepoju reported.
Previous data have shown that minimally invasive breast biopsies are less expensive, less scarring, require less recovery time, cause fewer complications, reduce the time between diagnosis and definitive treatment, produce fewer positive margins, and facilitate preoperative multidisciplinary treatment planning, compared with open breast biopsies.
The report from the third international consensus conference on image-detected breast cancer in 2009 called minimally invasive breast biopsy a best practice that should be the gold standard for initial diagnosis and proposed a goal of limiting open breast biopsy to 5%-10% of cases (J. Am. Coll. Surg. 2009;209:504-20).
Dr. Adepoju reported having no financial disclosures.
On Twitter @sherryboschert
Open breast biopsy accounted for 34% of breast biopsies in 25,965 U.S. inpatients between 2008 and 2010, a retrospective study found.
The finding suggests that minimally invasive breast biopsy techniques are underutilized, with a national rate that’s far off the widely acknowledge goal of having at least 90% of biopsies for suspicious breast lesions be minimally invasive, Dr. Linda Adepoju reported.
Most breast biopsies are performed in outpatient settings. Although the study analyzed a national data sample for hospitalized patients, the rate of open breast biopsy is consistent with previous studies of outpatient databases for individual institutions or states that have reported rates of open breast biopsy from 24% to 36%, noted Dr. Adepoju of the University of Toledo (Ohio).
She and her associates analyzed data from 46 states in the Healthcare Cost and Utilization Project National Inpatient Sample for 2008-2010, excluding 222 cases in which an open breast biopsy and minimally invasive breast biopsy were performed during the same hospital stay.
Open breast biopsy rates were significantly higher in women aged 49 years or younger (47%), compared with older women (29%), and in Asian women (40%) or Hispanic women (41%), compared with white women (34%) or black women (31%). Open breast biopsy also was significantly more likely in women who had private insurance than in women covered by Medicaid or Medicare – 41% vs. 31% (Am. J. Surg. 2014;208:382-90).
The type and location of hospital also was associated with open biopsy rates, with higher rates in small, private, rural, and/or nonteaching hospitals.
"Interventions targeting small, rural, and nonteaching hospitals could significantly decrease hospital costs and improve the overall quality of breast care," Dr. Adepoju and her associates commented, but "we must be sensitive" to the needs and limitations of various health care delivery settings, they added.
"A critical access hospital in rural Ohio may not be able to afford a mammographer and stereotactic equipment" for minimally invasive breast biopsy. Previous data "are clear that patients preferably seek their care in and near their community. Given workforce shortages and the current economic climate, this may mean accepting higher open breast biopsy rates in rural America," the investigators concluded.
Patients who had open breast biopsies in the current study were more likely to need more than one biopsy for diagnosis (1.2%), compared with women who had minimally invasive breast biopsies (0.5%). Hematoma drainage was needed in 1.4% of patients after open breast biopsy and 0.6% after minimally invasive biopsy. Open breast biopsy also was more expensive, based on analysis of data from the University of Toledo, averaging $1,700 in Medicare reimbursement, compared with $300-$1,100 for minimally invasive breast biopsy, depending on the specific procedure, Dr. Adepoju reported.
Previous data have shown that minimally invasive breast biopsies are less expensive, less scarring, require less recovery time, cause fewer complications, reduce the time between diagnosis and definitive treatment, produce fewer positive margins, and facilitate preoperative multidisciplinary treatment planning, compared with open breast biopsies.
The report from the third international consensus conference on image-detected breast cancer in 2009 called minimally invasive breast biopsy a best practice that should be the gold standard for initial diagnosis and proposed a goal of limiting open breast biopsy to 5%-10% of cases (J. Am. Coll. Surg. 2009;209:504-20).
Dr. Adepoju reported having no financial disclosures.
On Twitter @sherryboschert
FROM THE AMERICAN JOURNAL OF SURGERY
Key clinical point: Inpatient breast biopsies may underemploy minimally invasive techniques.
Major finding: Open breast biopsies comprised 34% of breast biopsies.
Data source: Retrospective analysis of National Inpatient Sample data on 25,965 women who underwent breast biopsy in 2008-2010.
Disclosures: Dr. Adepoju reported having no financial disclosures.
