As has been alluded to here in the past, the prevalence of breast cancer in our world is difficult to overstate. It’s a disease that knows no boundaries or restrictions, which sadly makes it a consistent, worldwide problem.
Naturally, this is all the more reason to check yourself regularly, and to ensure that you have a proper, thorough understanding of risks and warning signs. But it’s also a good reason to make sure you have a grasp on the treatment and procedure options available to you if you do have a warning sign, or something comes up in imaging
This brings us to lumpectomies and escisional biopsies, which are two of the primary options at hand when a breast abnormality needs to be sampled or withdrawn for examination. Specifically, a lumpectomy is defined as the “surgical removal of a small area of breast tissue” that is suspected of being cancerous. Some refer to the same procedure as a partial mastectomy. An excisional biopsy, meanwhile, is fundamentally a very similar procedure, but is considered to be more of a diagnostic exercise. Typically, a lumpectomy is performed when it is believed that tissue is cancerous, whereas an excisional biopsy is meant to sample tissue in order to determine whether or not it poses a threat.
Needless to say these can both be helpful and life-saving procedures. They are also minimally disruptive or invasive compared to some more drastic options, such as a full mastectomy (though they do not necessarily eliminate the potential of these options becoming necessary). That said, there are also other options in some cases that can be even more minimally invasive. Specifically, image-guided breast biopsies are preferred by some women where they are possible, and when lumps cannot be felt externally.
This alternate method essentially involves the use of an ultrasound to locate concerning tissue and then help to guide the radiologist to said tissue for removal. It is a direct and precise process made all the more convenient by the sophistication of today’s imaging equipment. Where ultrasounds were once somewhat clunky, today they are often smaller, more maneuverable, and in some cases even wireless. This can be chalked up in part to advancement in PCB design, which has produced smaller and more flexible circuit boards that allow for more creativity and convenience in device engineering. It can also be attributed to improved Wi-Fi and data networks, which have made healthcare practitioners more comfortable using connected devices and wireless tools. The end result though is that heading in for imaging, or an image-guided procedure, is often quicker and simpler today than in the past.
Ultimately it is wise for women to be aware of all of these options. Awareness makes it easier to make decisions when necessary, and increases comfort with different options. With our primary focus in this post on lumpectomies and excisional biopsies though, it is worth noting that these two options are more common than many might assume. This makes them particularly important to understand, even if it’s still a good idea to have a grasp on alternatives like image-guided biopsies.
Recently, data on breast-conserving surgeries (which is to say lumpectomies and excisional biopsies) suggested that there are about 170,000 such procedures on an annual basis in the United States. Roughly 20 to 25% of those, meanwhile, also require re-excision (a second procedure to clean up scattered cancer cells). We can’t say for certain, but that is likely to be a bigger number than a lot of people would guess. And that is why women should make a point of understanding these procedures — including when they’re needed, what they entail, and what alternative might be.
Medicare utilization of breast-conserving surgeries
Lumpectomies and excisional biopsies are primarily performed in the outpatient setting in the United States. Medicare is by far the largest payor, paying for roughly 50-60% of all breast conserving surgeries. Of all the surgeries in 2019 identified as either lumpectomies or non-diagnostic excisional biopsies, 85% were performed in the outpatient surgery department of Hospitals, and another 11% in Ambulatory Surgical Centers. The remainder is split between the office setting and inpatient setting.
When billing for lumpectomies, facilities mostly use the following CPT codes:
When billing for non-diagnostic excisional biopsies, facilities use the following CPT codes:
The above research was performed by the Carevoyance data team. If you have any questions about market sizing for lumpectomies, excisional biopsies, or for that matter, any other procedure, please don't hesitate to reach out.
Content written for carevoyance.com by Joanne Brown