Biopsy of the same organ within 30 days: a potential radiology performance measure

Abstract

Purpose: To assess the potential value of repeat image-guided biopsy within 30 days as a radiology performance metric.

Methods: This was a HIPAA-compliant IRB-approved retrospective cohort study of all consecutive ultrasound- and CT-guided core biopsies of the chest, abdomen, and pelvis performed at one institution November 2016 to June 2020. The inclusion criterion was repeat biopsy of the same organ within 30 days of the initial biopsy. Details of both biopsies were recorded, including indication, organ, post-biopsy histology, performing service, performing provider. Histologic concordance between initial and repeat biopsies was calculated. Proportions and 95% confidence intervals were calculated.

Results: Repeat biopsy was performed after 1.9% (95% CI 1.5-2.4% [N = 89]) of 4637 initial biopsies. For structures with ≥ 100 biopsies performed, the repeat biopsy proportion ranged from 1.3% (5/378, US-guided renal biopsy) to 2.7% (11/413, CT-guided retroperitoneal biopsy). The most common indication for initial biopsy was possible malignancy (66% [59/89]). The most common indication for repeat biopsy was radiology-histology discrepancy (36% [32/89]). Repeat biopsies were more likely to show malignant cells and to have diagnostic tissue (Repeat: 48.3% malignant; 20.2% benign; 1.1% nondiagnostic; Initial: 25.8% malignant; 23.6% benign; 14.6% nondiagnostic). The most common histology difference after repeat biopsy was a change in malignant diagnosis (38.2% [34/89]).

Conclusion: Repeat percutaneous biopsy within 30 days of the same organ is uncommon (~ 2%), but when indicated, it commonly changes diagnosis and improves diagnostic yield. Repeat biopsy within 30 days is a potential performance measure for radiology procedure services.

Keywords: Biopsy; Cross-sectional; Image-guided; Metric; Quality; Repeat; Value.