Effect of advanced imaging technology on how biopsies are done and who does them

Abstract

Purpose: To assess national levels and trends in utilization of biopsy procedures during the past decade and investigate the relative roles of biopsy approaches (open, endoscopic, and percutaneous) and physician specialties.

Materials and methods: Institutional review board approval was not necessary because only public domain data were used. Aggregated Medicare claims data were used to determine utilization of biopsies performed in 10 anatomic regions from 1997 to 2008. Utilization levels according to biopsy approach and anatomic region were calculated. Trends in the relative utilization of percutaneous needle biopsy (PNB) and imaging-guided percutaneous biopsy (IGPB) were assessed. The relative roles of radiologists and nonradiologists in the performance of all biopsies, PNBs, and IGPBs were evaluated.

Results: Biopsy procedures with all approaches increased from 1380 to 1945 biopsies per 100,000 Medicare enrollees between 1997 and 2008, which represents a compound annual growth rate (CAGR) of 3%. Utilization of non-PNBs fell, while the absolute level and relative share of PNBs increased. In 2008, 67% of all biopsies were performed by using a percutaneous route. IGPB as a percentage of all PNBs increased over time in the regions for which data were available. Radiology was the leading specialty providing biopsy services. The total number of biopsies performed by radiologists increased at a CAGR of 8%, and radiologists' share of all biopsies increased from 35% to 56%.

Conclusion: During the past decade, there was continuing substitution away from invasive approaches and non-imaging-guided percutaneous approaches in favor of PNBs and IGPBs, likely related to increasing use of advanced imaging modalities for biopsy guidance. Consequently, radiologists are performing an increasing share of biopsies across all anatomic regions.

Figure 1:

Graph shows percentage of biopsies performed with percutaneous approach according to anatomic region in 1997, 2002, and 2008. Lymph node = superficial lymph nodes, Soft tissues = soft tissues of the musculoskeletal system.

Figure 2:

Pie chart shows biopsies according to anatomic region as a percentage of all biopsies performed by radiologists in 2008. Lymph node = superficial lymph nodes, Soft tissue = soft tissue of the musculoskeletal system.

Figure 3:

Graph shows percutaneous breast core biopsies performed with or without imaging guidance as a percentage of all percutaneous breast biopsies from 2002 to 2008.

Figure 4:

Graph shows FNAs performed with or without imaging guidance as a percentage of all FNAs from 2004 to 2008.

Figure 5:

Graph shows relative share of all biopsies performed according to specialty from 1997 to 2008. * = Data in 2003 were affected by a coding discrepancy for FNAs.

Figure 6:

Graph shows radiologists’ share of percutaneous biopsy procedures according to anatomic region from 1997 to 2008. * = Data in 2003 were affected by a coding discrepancy for FNAs.