Annals of Surgical Oncology

, Volume 24, Issue 3, pp 676–682 | Cite as

Ultrasound-Guided Core-Needle Versus Vacuum-Assisted Breast Biopsy: A Cost Analysis Based on the American Society of Breast Surgeons’ Mastery of Breast Surgery Registry

Breast Oncology



To evaluate the cost-efficacy of vacuum-assisted ultrasound-guided breast biopsy instruments compared to ultrasound-guided 14-gauge spring-loaded core-needle biopsy.


The American Society of Breast Surgeons’ Mastery of Breast Surgery Registry was reviewed. Biopsy findings, any rebiopsy, and the instrument used were abstracted for 31,451 ultrasound-guided biopsy procedures performed between 2001 and July 2014. Rates of cancer diagnosis and rebiopsy were calculated for each instrument. A linear mathematical model was developed to calculate total cost per cancer diagnosis, including procedural costs and the costs of any additional surgical rebiopsy procedures. Mean cost per cancer diagnosis with confidence limits was then determined for 14-gauge spring-loaded core-needle biopsy and 14 different vacuum-assisted instruments. For 14-gauge spring-loaded core-needle biopsy, mean cost per cancer diagnosis was $4346 (4327–$4366). For the vacuum-assisted instruments, mean cost per cancer diagnosis ranged from a low of $3742 ($3732–$3752) to a high of $4779 ($4750–$4809).


Vacuum-assisted instruments overall were more cost-effective than core with a mean cost per cancer diagnosis of $4052 ($4038–$4067) (p < 0.05). Tethered vacuum-assisted instruments performed best with a mean cost per cancer diagnosis of $3978 ($3964–$3991) (p < 0.05). Nontethered devices had a mean cost per cancer diagnosis of $4369 ($4350–$4388), a result no better than core (p < 0.05).


Ultrasound-guided vacuum-assisted breast biopsy had a lower mean cost per cancer diagnosis than 14-gauge spring-loaded core-needle biopsy. This advantage was only seen in tethered vacuum-assisted instruments. Within device families, larger instruments tended to outperform smaller instruments.


  1. 1.
    Silverstein MJ, et al. Image-detected breast cancer: state of the art diagnosis and treatment. J Am Coll Surg. 2005;201:586–97.CrossRefPubMedGoogle Scholar
  2. 2.
    Bruening W, et al. Systematic review: comparative effectiveness of core-needle and open surgical biopsy to diagnose breast lesions. Ann Intern Med. 2010;152:238–46.CrossRefPubMedGoogle Scholar
  3. 3.
    Jackman RJ, et al. Atypical ductal hyperplasia diagnosed at stereotactic breast biopsy: improved reliability with 14-gauge, directional, vacuum-assisted biopsy. Radiology. 1997;204:485–8.CrossRefPubMedGoogle Scholar
  4. 4.
    Philpotts LE, Hooley RJ, Lee CH. Comparison of automated versus vacuum-assisted biopsy methods for sonographically guided core biopsy of the breast. AJR Am J Roentgenol. 2003;180:347–51.CrossRefPubMedGoogle Scholar
  5. 5.
    Yu YH, Liang C, Yuan XZ. Diagnostic value of vacuum-assisted breast biopsy for breast carcinoma: a meta-analysis and systematic review. Breast Cancer Res Treat. 2010;120:469–79.CrossRefPubMedGoogle Scholar
  6. 6.
    Grady I, Gorsuch H, Wilburn-Bailey S. Ultrasound-guided, vacuum-assisted, percutaneous excision of breast lesions: an accurate technique in the diagnosis of atypical ductal hyperplasia. J Am Coll Surg. 2005;201:14–7.CrossRefPubMedGoogle Scholar
  7. 7.
    Kim MJ, et al. Breast lesions with imaging-histologic discordance during US-guided 14G automated core biopsy: can the directional vacuum-assisted removal replace the surgical excision? Initial findings. Eur Radiol. 2007;17:2376–83.CrossRefPubMedGoogle Scholar
  8. 8.
    Berg WA. Image-guided breast biopsy and management of high-risk lesions. Radiol Clin North Am. 2004;42:935–46, vii.Google Scholar
  9. 9.
    Jackman RJ, et al. Stereotactic, automated, large-core needle biopsy of nonpalpable breast lesions: false-negative and histologic underestimation rates after long-term follow-up. Radiology. 1999;210:799–805.CrossRefPubMedGoogle Scholar
  10. 10.
    Jang M, et al. Underestimation of atypical ductal hyperplasia at sonographically guided core biopsy of the breast. AJR Am J Roentgenol. 2008;191:1347–51.CrossRefPubMedGoogle Scholar
  11. 11.
    American Society of Breast Surgeons. Mastery of breast surgery registry. Module 1. 2001–2014.
  12. 12.
    American Medical Association. Current procedural terminology. Standard ed. Chicago: American Medical Association; 2015.Google Scholar
  13. 13.
    Centers for Medicare and Medicaid Services. CMS-1612-FC. PFS final rule with comment: relative value file. 2015.
  14. 14.
    Centers for Medicare and Medicaid Services. CMS-1613-FC. Ambulatory surgical center payment—final rule with comment period. 2015.
  15. 15.
    Mullahy J. Econometric modeling of health care costs and expenditures: a survey of analytical issues and related policy considerations. Med Care. 2009;47(7 Suppl 1):S104–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Moran JL, Solomon PJ, Peisach AR, Martin J. New models for old questions: generalized linear models for cost prediction. J Eval Clin Pract. 2007;13:381–9.CrossRefPubMedGoogle Scholar
  17. 17.
    Blough DK. Using generalized linear models to assess medical care costs. Health Serv Outcomes Res Methodol. 2000;1:185–202.CrossRefGoogle Scholar
  18. 18.
    White GC, Bentts RE. Analysis of frequency count data using the negative binomial distribution. Ecology. 1996;77:2549–57.CrossRefGoogle Scholar
  19. 19.
    Feller W. Über den zentralen Genzwertsatz der Wahrscheinlichkeitsrechnung. Biometrika. 1935;40:521–59.Google Scholar

Copyright information

© Society of Surgical Oncology 2016

Authors and Affiliations

  • Ian Grady
    • 1
  • Tony Vasquez
    • 2
  • Sara Tawfik
    • 3
  • Sean Grady
    • 4
  1. 1.North Valley Breast ClinicReddingUSA
  2. 2.Karuk Tribal Health ProgramYrekaUSA
  3. 3.Department of Radiology, Kasr Al-Aini School of MedicineCairo UniversityCairoEgypt
  4. 4.Department of Computer Science and EngineeringUniversity of California, San DiegoLa JollaUSA

Personalised recommendations