JACR: False alarm Surgical breast biopsies not overused

Concerns that surgical breast biopsies, as opposed to percutaneous core needle biopsies (PNB), were being overused may be unfounded as the true surgical breast biopsy rate is likely somewhere between 2 percent and 18 percent, which is close to the recommended rate, according to a study published in the February issue of the Journal of the American College of Radiology (JACR).

Recently, a study in the American Journal of Surgery (AJS) found the rate of open surgical breast biopsy among a large group of women in Florida was around 30 percent, with the rest undergoing a much less invasive PNB.

David C. Levin, MD, of Thomas Jefferson University Hospital in Philadelphia, and colleagues in JACR explained that a lower rate of 10 percent would be more appropriate. The AJS study sparked outrage that money was being wasted and women were undergoing unnecessary surgery.

“Needless to say, this discussion did not cast physicians associated with breast care in a very favorable light,” wrote Levin et al.

Levin and colleagues weren’t convinced, however, and noted that the AJS paper included the CPT code 19125 (“excision of breast lesion identified by preoperative placement of radiological marker, open”) in its biopsy volume count. Since this code can be used for excision of a lesion rather than just biopsy, the researchers set out to more accurately assess the use of PNB compared with surgical biopsy.

Using Medicare Part B databases for 2004 to 2009, the researchers tracked trends in the use of codes 19100 (PNB without imaging), 19102 and 19103 (PNB with imaging), 19101 (open biopsy) and 19125.

They found that over the study period, volumes of PNB with imaging rose significantly as claims for codes 19102 and 19103 increased 12 and 42 percent, respectively. Conversely, the volume of code 19125 dropped 39 percent.

If it’s assumed that all 19125 claims were for biopsy, then the surgical biopsy rate in 2009 would have been 18.3 percent. However, if it’s assumed that all 19125 claims were for excisions, then the surgical biopsy rate plunges to 2.2 percent. The authors acknowledged that it’s not possible to gauge the surgeons’ intent in these cases, and that those assumptions represent the outer limits of the correct range. They also ran the numbers based on a third assumption that half the 19125 claims were for surgical biopsy.

“Although impossible to prove, this assumption is probably closer to reality than either of the others,” wrote the authors. “It estimates that 11 percent of all biopsies are performed surgically, a figure very close to the presumed ‘correct’ figure of 10 percent.”

Given the results of their study, Levin et al concluded that the AJS paper and the controversy it sparked misrepresent the situation.

“In reality, surgeons and radiologists involved in breast care seem to be cooperating well and following appropriate pathways of care. Surgical breast biopsy is not being overused,” they wrote.