Use of Percutaneous Needle Biopsies Continues to Grow

By Todd Neale, Staff Writer, MedPage Today

Published: June 29, 2010
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner
 
In recent years, there has been an increase in the use of percutaneous needle biopsies -- including those guided by advanced imaging -- and a shift away from more invasive biopsy techniques, researchers found.

Highlighting the growing use of imaging guidance, radiologists have taken on an increasing share of biopsies (from 35% in 1997 to 56% in 2008), Sharon Kwan, MD, of the University of California San Francisco, and colleagues reported online in the journal Radiology.

Kwan and her colleagues analyzed Medicare claims data for biopsies in 10 anatomic regions -- the abdomen and retroperitoneum, bone, breast, chest, kidney, liver, musculoskeletal soft tissue, pancreas, superficial lymph node, and thyroid -- from 1997 to 2008.

During that time, the researchers found that the proportion of biopsies performed percutaneously increased from 59% to 67%. The rise was seen for six of the 10 anatomic regions studied -- breast, chest, liver, lymph node, pancreas, and musculoskeletal soft tissue.

"A likely explanation [for the increase in percutaneous approaches] is that the relatively recent proliferation of CT, MR imaging, and ultrasound had an effect on the overall approach used for performing biopsies, because more lesions can be efficiently and safely targeted with a percutaneously inserted needle now that imaging guidance is more readily available."

Overall, biopsy procedures increased from 1,380 per 100,000 beneficiaries in 1997 to 1,945 in 2008, for a modest annual growth rate of 3%.

Over the study period, the number of percutaneous techniques rose by 5% a year, while nonpercutaneous approaches dropped 3% a year.

"Because percutaneous needle biopsy techniques were established well over a half-century ago, we might have expected that the distribution of biopsy approach would have stabilized prior to our study period," Kwan and colleagues commented.

In 2008, there were only two anatomic regions for which a minority of biopsies were performed percutaneously -- superficial lymph nodes (46%) and musculoskeletal soft tissues (30%). Open biopsies are associated with less morbidity in these superficial regions, according to the authors.

Most of the codes used in the analysis did not distinguish between biopsies performed with and without imaging guidance. However, codes specifying the use of imaging were introduced in 2001 and 2002 for breast biopsies and fine needle aspirations, respectively.

For both of these procedures, the proportion guided by imaging increased -- from 85% in 2002 to 95% in 2008 for breast core biopsies and from 54% in 2004 to 77% in 2008 for fine needle aspirations.

By the end of the study period, radiologists were performing most biopsies (56%), with the growth in that number increasing by 8% a year. However, the rate of growth of radiologist-performed biopsies slowed from 9% a year from 1997 to 2002 and to 6% from 2004 to 2008.

"One factor that might contribute to this slowdown is that other specialties are increasingly performing imaging-guided percutaneous biopsy," the researchers wrote.

They acknowledged some limitations, including some irregularities in the data for fine needle aspirations in 2003 and the lack of information on which anatomic regions were biopsied with fine needle aspiration.

In addition, the findings may not apply to a non-Medicare population, information on the use of imaging guidance was not available for all anatomic sites, and the researchers were not able to capture the full range of biopsy procedures for the abdomen.

The study was supported by a National Institute of Biomedical Imaging and Bioengineering grant.
The authors reported that they had no conflicts of interest.

Primary source: Radiology
Source reference:
Kwan S, et al "Effect of advanced imaging technology on how biopsies are done and who does them" Radiology 2010; DOI: 10.1148/radiol.10092130.

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