Automatically testing all core needle biopsy specimens showing ductal carcinoma in situ (DCIS) for estrogen receptor (ER) and progesterone receptor (PR) is highly expensive and may not be needed, according to a study published in the American Journal of Surgical Pathology.
For the study, researchers led by Pedram Argani, MD, Johns Hopkins Hospital (Baltimore, MD), looked at 58 core needle biopsies performed in 2011 and 2012 that showed pure DCIS and also had a resulting surgical specimen at Johns Hopkins.
------
Related Content
New ASCO guidelines clarify use of biomarkers to guide adjuvant therapy for early-stage invasive breast cancer
Use of Recurrence Assay in Guiding Chemotherapy Decisions
-----
On surgical excision, they found that 5 biopsies (8.6%) had only benign findings, 44 biopsies (75.9%) had pure DCIS, and 9 biopsies (15.5%) had DCIS with invasive mammary carcinoma. All cases were tested for ER and PR prior to excision, but the 9 cases with invasive mammary carcinoma in the surgical excision specimen and the 4 cases of pure DCIS in surgical excision specimens that were initially ER/PR negative on core needle biopsy still had to be retested, resulting in unnecessary costs of $8148.92 (about $140 per patient for the 58 patients in the study).
Overall, Dr Argani and his colleagues determined that ER/PR testing influenced patient management in only 16 of 49 pure DCIS cases after surgical excision, indicating that more than $20,000 of unnecessary testing had been performed. PR testing could also have been omitted in the 16 cases in which ER/PR results were used, which would have saved $5014.72, or $86.46 per patient. Extrapolating these costs, researchers estimated that this same clinical procedure could cost the United States more than $35 million a year.
Therefore, researchers concluded that because standard treatment does not change based on the results of ER/PR testing prior to surgical excision, tests should only be ordered after specimens have been obtained and when hormone therapy has been discussed as a serious treatment option with patients.
