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Campbell WA, Chick JFB, Shin DS, Makary MS. Value of interventional radiology and their contributions to modern medical systems. FRONTIERS IN RADIOLOGY 2024; 4:1403761. [PMID: 39086502 PMCID: PMC11288872 DOI: 10.3389/fradi.2024.1403761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 06/25/2024] [Indexed: 08/02/2024]
Abstract
Interventional radiology (IR) is a unique specialty that incorporates a diverse set of skills ranging from imaging, procedures, consultation, and patient management. Understanding how IR generates value to the healthcare system is important to review from various perspectives. IR specialists need to understand how to meet demands from various stakeholders to expand their practice improving patient care. Thus, this review discusses the domains of value contributed to medical systems and outlines the parameters of success. IR benefits five distinct parties: patients, practitioners, payers, employers, and innovators. Value to patients and providers is delivered through a wide set of diagnostic and therapeutic interventions. Payers and hospital systems financially benefit from the reduced cost in medical management secondary to fast patient recovery, outpatient procedures, fewer complications, and the prestige of offering diverse expertise for complex patients. Lastly, IR is a field of rapid innovation implementing new procedural technology and techniques. Overall, IR must actively advocate for further growth and influence in the medical field as their value continues to expand in multiple domains. Despite being a nascent specialty, IR has become indispensable to modern medical practice.
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Affiliation(s)
- Warren A. Campbell
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Virginia, Charlottesville, VA, United States
| | - Jeffrey F. B. Chick
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Washington, Seattle, WA, United States
| | - David S. Shin
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Southern California, Los Angeles, CA, United States
| | - Mina S. Makary
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
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Watson JF, Radic R, Frost R, Paton S, Kessell MA, Dessauvagie BF, Taylor DB. Vacuum-assisted excision biopsy for definitive diagnosis of breast lesions of uncertain malignant potential (B3 lesions) on core biopsy - A single centre Western Australian experience. J Med Imaging Radiat Oncol 2023. [PMID: 36596982 DOI: 10.1111/1754-9485.13502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 12/07/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION In Australia, the usual approach to breast lesions where core biopsy returns an uncertain result ("B3" breast lesion) is to perform surgical diagnostic open biopsy (DOB). This is associated with patient time off work, costs of hospital admission, risks of general anaesthesia and surgical complications. The majority of B3 lesions return benign results following surgery. Vacuum assisted excision biopsy (VAEB) is a less invasive, lower cost alternative, and is standard of care for selected B3 lesions in the United Kingdom. Similar use of VAEB in Australia, could save many women unnecessary surgery. The aim of this study was to document our experience during the introduction of VAEB as an alternative to DOB for diagnosis of selected B3 lesions. METHODS The multidisciplinary team developed an agreed VAEB pathway for selected B3 lesions. Technically accessible papillary lesions, mucocele-like lesions and radial scars without atypia measuring ≤ 15mm were selected. RESULTS Over a 7 month period, 18 women with 20 B3 lesions were offered VAEB. 16 women (18 lesions) chose VAEB over DOB. Papillomas were the commonest lesion type. All lesions were successfully sampled: 17/18 were benign. One lesion (6%) was upgraded to malignancy (ductal carcinoma in situ on VAEB, invasive ductal carcinoma at surgery). No major complications occurred. Patient satisfaction was high: 15/16 respondents would again choose VAEB over surgery. CONCLUSION VAEB is a patient-preferred, safe, well-tolerated, lower-cost alternative to DOB for definitive diagnosis of selected B3 breast lesions.
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Affiliation(s)
- Jessica Frances Watson
- Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Perth, Western Australia, Australia.,Nepean Hospital, Sydney, New South Wales, Australia
| | - Rose Radic
- Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Rosanna Frost
- Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Perth, Western Australia, Australia.,Royal United Hospitals Bath, NHS Foundation Trust, Bath, UK
| | - Sarah Paton
- Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Meredith Anita Kessell
- Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Benjamin Frederik Dessauvagie
- Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Perth, Western Australia, Australia.,PathWest Laboratory Medicine WA, Fiona Stanley Hospital, Perth, Western Australia, Australia.,University of Western Australia Medical School, Perth, Western Australia, Australia
| | - Donna Blanche Taylor
- Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Perth, Western Australia, Australia.,University of Western Australia Medical School, Perth, Western Australia, Australia.,BreastScreen WA, Perth, Western Australia, Australia
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Tsai HY, Huang ST, Chao MF, Kan JY, Hsu JS, Hou MF, Chiu HC. Cost-effectiveness of stereotactic vacuum-assisted biopsy for nonpalpable breast lesions. Eur J Radiol 2020; 127:108982. [PMID: 32334370 DOI: 10.1016/j.ejrad.2020.108982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 03/26/2020] [Accepted: 03/29/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE To examine the potential cost-savings of stereotactic vacuum-assisted biopsy (SVAB) over open surgical biopsy (OSB) in diagnosis of nonpalpable lesions on mammography and to estimate the cost-saving effect on lesions at different levels of malignant probability. METHODS This retrospective study was approved by our Institutional Review Board. We retrospectively reviewed 276 (33.8 %) SVAB and 541 (66.2 %) OSB medical records at a medical center. Direct costs included patients' self-paid and national health insurance claim charges. Indirect costs were calculated using sick days, average salary, and age-adjusted employment rate. One-way and two-way sensitivity analyses were conducted. Lesion classification was determined by the assessment categories of Breast Imaging Reporting and Data System (BI-RADS), 4th or 5th editions. RESULTS SVAB decreased the direct cost by $90.3 (10.1 %) per diagnosis. The indirect cost was decreased by $560.2 (96.0 %). Overall, SVAB saved 43.9 % of resource utilization for each biopsy. Taking the cost of the subsequent malignant surgery into account, from the healthcare providers' perspective, SVAB was cost-effective if a lesion had less than 19 % likelihood of malignancy. From the societal perspective, SVAB reduced productivity loss for all the lesions. Based on the positive predictive value of the BI-RADS categories, SVAB was more suitable for the lesions of category 4A and category 3, resulting in greater savings in both medical and societal resources. CONCLUSIONS SVAB is a cost-effective diagnostic option for nonpalpable breast lesions. The cost-saving effect is greater for the lesions of category 4A and category 3.
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Affiliation(s)
- Huei-Yi Tsai
- Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan No.100, Ziyou 1st Rd., Sanmin Dist., Kaohsiung City, 807, Taiwan; Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan No.100, Shiquan 1st Rd., Sanmin Dist., Kaohsiung City, 807, Taiwan
| | - Siou-Tang Huang
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan No.100, Shiquan 1st Rd., Sanmin Dist., Kaohsiung City, 807, Taiwan
| | - Min-Fang Chao
- Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan No.100, Ziyou 1st Rd., Sanmin Dist., Kaohsiung City, 807, Taiwan
| | - Jung-Yu Kan
- Division of Breast Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan No.100, Ziyou 1st Rd., Sanmin Dist., Kaohsiung City, 807, Taiwan
| | - Jui-Sheng Hsu
- Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan No.100, Ziyou 1st Rd., Sanmin Dist., Kaohsiung City, 807, Taiwan
| | - Ming-Feng Hou
- Division of Breast Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan No.100, Ziyou 1st Rd., Sanmin Dist., Kaohsiung City, 807, Taiwan
| | - Herng-Chia Chiu
- Institute of Hospital Management, Tsinghua Shenzhen International Graduate School, Tsinghua University No. 2279 Lishui Road, Nanshan District, Shenzhen, 518055, PR China.
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Tsai HY, Chao MF, Ou-Yang F, Kan JY, Hsu JS, Hou MF, Chiu HC. Accuracy and outcomes of stereotactic vacuum-assisted breast biopsy for diagnosis and management of nonpalpable breast lesions. Kaohsiung J Med Sci 2019; 35:640-645. [PMID: 31271510 DOI: 10.1002/kjm2.12100] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 05/27/2019] [Indexed: 11/10/2022] Open
Abstract
Stereotactic vacuum-assisted biopsy (SVAB) is an alternative method of breast biopsy for nonpalpable lesions detected by mammography. Considering the diagnostic effectiveness, a direct comparison of SVAB and open surgical biopsy (OSB) is lacking. We performed a retrospective review of 276 (33.8%) SVAB and 541 (66.2%) OSB to compare the diagnostic accuracy and the total number of procedures the patients underwent. The negative predictive values of OSB and SVAB were 99.77% and 99.61%, and their false-negative rates were 0.96% and 4.76%, respectively. SVAB, as the first-line biopsy method, obviated 92.3% of operations. All malignancies diagnosed using SVAB could be treated with single therapeutic surgery. By contrast, 48% of malignancies of OSB group received two operations. Breast Imaging Reporting and Data System (BI-RADS) category used at the study correlated well with the percentage of malignancy and can thus be used to predict biopsy results. Our study concluded that SVAB is reliable for diagnosing nonpalpable breast lesions and is the better biopsy method for categories 3 and 4A lesions, which reduces the benign surgery rate. For lesions with a higher likelihood of malignancy, BI-RADS 4B, 4C and 5, SVAB has an advantage over OSB, which lowers the total number of operations for malignancy treatment.
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Affiliation(s)
- Huei-Yi Tsai
- Department of Radiology, St. Joseph Hospital, Kaohsiung, Taiwan.,Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Min-Fang Chao
- Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Fu Ou-Yang
- Division of Breast Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Jung-Yu Kan
- Division of Breast Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Jui-Sheng Hsu
- Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ming-Feng Hou
- Division of Breast Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Herng-Chia Chiu
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan
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