Radiology: Image-guided biopsies on upward trend

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Radiologists are performing an increasing share of biopsies across all anatomic regions, and there has been a shift away from invasive approaches and non-image-guided percutaneous approaches toward percutaneous needle biopsy (PNB) and image-guided percutaneous biopsy (IGPB) over the past decade, found a study published online June 29 in Radiology.

In assessing national biopsy utilization trends, Sharon W. Kwan, MD, a radiology resident at the University of California, San Francisco, and colleagues evaluated physician specialties and the relative roles of various biopsy approaches, including open, endoscopic and percutaneous methods.

The study assessed Medicare claims data from 1997 through 2008 to determine biopsy use and approach in 10 different anatomical regions. Researchers also reviewed utilization trends of PNB and IGPB  and the roles of radiologists and nonradiologists in the performance of all biopsies.

For every 100,000 biopsy procedures for Medicare enrollees, Kwan and colleagues found an increase from 1,380 to 1,945 procedures from the beginning of the study period in 1997 to the end in 2008, signifying a compound annual growth rate of three percent.

In addition, researchers noted that the utilization rates of non-PNBs dropped off, while the absolute level and relative share of PNBs increased. In 1997, percutaneous biopsies accounted for 59 percent of all biopsies; the figure climbed to 67 percent in 2008.

During the decade-long study period, the portion of biopsies performed by radiologists increased from 35 percent to 56 percent; however, the annual rate of growth in biopsies performed by radiologists dropped from eight percent in the first half of the study period to six percent in the second half. Researchers attributed the trend to the increasing number of imaging-guided biopsies performed by other specialists.

The decreasing use of more invasive open biopsies and non-image-guided percutaneous biopsies “most likely is related to increasing use of advanced imaging modalities for biopsy guidance,” said Kwan, noting that “the technique enables more efficient and safe targeting of lesions.”

However, despite growth imaging utilization,  the growth in overall biopsy utilization in the past decade increased only three percent. The researchers noted that fears over increased imaging utilization leading to additional costly workups, including biopsies, may be to blame.

“The approach with which biopsies are performed evolved in the past decade, with continuing substitution away from more invasive and nonimaging guided percutaneous biopsy approaches in favor of imaging-guided percutaneous approaches,” concluded Kwan and colleagues, noting that “recent trends suggest that the portion of biopsies performed with imaging guidance will continue to increase.”