But the spread of advanced imaging doesn't seem to have dramatically increased the number of biopsies performed - a concern in the medical community. Biopsy procedures rose from 1,380 to 1,945 biopsies per 100,000 Medicare enrollees between 1997 and 2008, the researchers found, at a CAGR of what the study's authors deemed a "modest" 3 percent.

TRACKING IMAGE-GUIDED BIOPSIES

Because the Medicare codes the researchers used didn't distinguish between percutaneous needle procedures performed with or without imaging guidance, the researchers could only track the growth of image-guided needle biopsies for breast and fine needle aspirations, both of which account for the majority of PNBs performed, the researchers said.

For breast core biopsies, image-guided ones rose from 85 percent to 95 percent between 2002 and 2008, the researchers said. For fine needle aspirations, the image-guided set rose from 54 percent to 77 percent during the same period.

Interestingly, as most fine needle aspirations, or FNAs, largely target the thyroid, the share of these procedures performed by endocrinologists has risen at the expense of radiologists, according to the researchers. As of 2008, endocrinologists performed one-fifth of image-guided FNAs, compared to about one-tenth in 2004. Radiologists performed close to half of FNAs in 2008, the researchers said, less than the 70 percent share they had six years ago.

Still, there are exceptions to the image-guided and PNB trend. A minority of biopsies for lymph nodes and musculoskeletal soft tissue are percutaneous needle biopsies, the researchers found, although the numbers do seem to be rising. In fact, lymph node biopsies saw one of the biggest jumps in radiologist involvement, up from around 12 percent close to a decade ago to 70 percent in 2008, for a CAGR of a whopping 22 percent.

But the reason these procedures are still minority PNB, the researchers suspect, is that these are mostly superficial tissues where targets are more easily got by feel or sight.

"If you have a lump in your forearm," Kwan said, "[you] may not need to have a CT or an ultrasound to guide the needle to that spot, versus if you had a lesion in the kidney, it'd be pretty difficult to guide the needle without imaging in the right spot."

For bone, strangely, the rate of PNBs declined over the past 10 years, although Kwan said this could be an artifact from having to rely on aggregated Medicare claims data. For instance, abdominal biopsy rates were probably slightly underestimated in the study, the researchers suspect, because these are usually coded as part of laparoscopic procedures.

"If you take a too granular look at these procedures, some potentially false trends [emerge]," Kwan said. "That's why we wanted to report things as a whole."

Back to HCB News

More Industry Headlines