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Cost-effectiveness of MR Imaging and Core-Needle Biopsy in the Preoperative Work-up of Suspicious Breast Lesions¹

¹ From the School of Medicine (J.M.H.), the Departments of Radiology (J.M.H., C.P.L., S.G.O., M.D.S.) and Medicine (K.R.F., J.S.S.), the Center for Clinical Epidemiology and Biostatistics (C.P.L.), and the Leonard Davis Institute of Health Economics (C.P.L., J.S.S.), University of Pennsylvania Medical Center, Philadelphia. From the 1997 RSNA scientific assembly. Received September 29, 1997; revision requested November 26; final revision received January 27, 1999; accepted April 30. Supported in part by National Institutes of Health grants R01-CA58358 and R29-LM06238, U.S. Army grant RP950855, U.S. Department of Health and Human Services grant RFP #282-96-0026, and an American Heart Association Student Research Fellowship. Address reprint requests to C.P.L., 5 Biddle Way, Mount Laurel, NJ 08054 (e-mail: langlotz@erols.com).

View larger version (26K): [in a new window]   Figure 1a. Diagram depicts decision tree. (a) A woman with a suspicious breast lesion can choose breast MR imaging, CNB, or EXB as a diagnostic work-up option. CA = cancer, DCIS = ductal carcinoma in situ, FN = false-negative, FP = false-positive, f/u = follow-up, MRI = MR imaging, Node-neg = node-negative, Node-pos = node-positive, TN = true-negative, TP = true-positive, = transition state, M = Markov node. (b) Typical Markov subtree for a woman who had node-negative breast cancer depicts all possible transition states (), which appear immediately to the right of the Markov node (M). In b, numbers represent the probability of moving from one state to another for a patient who survives EXB. Chemo = chemotherapy, s/e = side effects.

View larger version (22K): [in a new window]   Figure 1b. Diagram depicts decision tree. (a) A woman with a suspicious breast lesion can choose breast MR imaging, CNB, or EXB as a diagnostic work-up option. CA = cancer, DCIS = ductal carcinoma in situ, FN = false-negative, FP = false-positive, f/u = follow-up, MRI = MR imaging, Node-neg = node-negative, Node-pos = node-positive, TN = true-negative, TP = true-positive, = transition state, M = Markov node. (b) Typical Markov subtree for a woman who had node-negative breast cancer depicts all possible transition states (), which appear immediately to the right of the Markov node (M). In b, numbers represent the probability of moving from one state to another for a patient who survives EXB. Chemo = chemotherapy, s/e = side effects.

View larger version (14K): [in a new window]   Figure 2. Diagram depicts sensitivity analysis of the disutility of EXB. The optimal strategy changes from EXB to MR imaging at a threshold of 0.005 year, or 2 days, and from MR imaging to CNB at a threshold of 0.058 year, or 21 days. dEXB = disutility of EXB, MRI = MR imaging, NCB = core-needle biopsy, QALE = quality-adjusted life expectancy.