Low Utility of Screening Hematologic Testing for Image-Guided Biopsies in Patients Without Bleeding Risks

Healthcare systems routinely perform prebiopsy coagulation testing for patients scheduled for image-guided percutaneous biopsies. Prior research has shown that such testing is standard for patients with known bleeding risks. However, no prior work had resolved whether the same testing is necessary for patients without known bleeding risks. This gap motivated an investigation into the frequency of abnormal coagulation results in this low-risk group. It was already known that abnormal INR and low platelet counts can increase bleeding risk during procedures. That uncertainty drove the need to assess how often these abnormalities occur in patients without predisposing conditions. No prior work had resolved the financial impact of routine testing in this population. Researchers have not yet established whether eliminating testing could reduce costs without compromising safety. This study aimed to clarify the clinical and economic relevance of prebiopsy coagulation testing in this specific patient group.

The study aimed to evaluate the prevalence of abnormal INR and platelet counts in patients without known bleeding risks who were scheduled for image-guided percutaneous biopsies. The motivation stemmed from the lack of evidence on whether routine coagulation testing is necessary in this low-risk group. Researchers sought to determine how often abnormal results occur in these patients. They also wanted to assess the financial impact of performing unnecessary tests. The specific problem addressed was the potential overuse of prebiopsy testing in patients who are unlikely to have abnormal results. The study aimed to provide data to guide clinical decision-making. It also sought to quantify the costs associated with unnecessary testing. This information could help institutions optimize testing protocols and reduce healthcare spending.

The study reviewed electronic medical records from a single institution's radiology department over a 10-year period. Researchers identified patients scheduled for percutaneous biopsies between 2007 and 2016. They collected demographic data and medical history, focusing on conditions that predispose to bleeding. INR and platelet counts were recorded within 30 days before the biopsy. The data were stratified into biopsies that were performed versus those that were cancelled. Patients were categorized based on whether they had known bleeding risk factors. The study compared the frequency of abnormal coagulation results between patients with and without predisposing conditions. Researchers calculated the financial costs associated with unnecessary testing.

Over 10 years, 3864 biopsies were performed, and 6371 were cancelled. Of the patients without known bleeding risks, 0.8% had an INR greater than 1.5, and 0.1% had an INR greater than 1.8. Only 0.4% had a platelet count of 50,000/μL or less. In patients without known bleeding risks who had biopsies cancelled, 0.6% had an INR greater than 1.5, and 0.0% had an INR greater than 1.8. Only 0.1% had a platelet count of 50,000/μL or less. The study found that abnormal coagulation results were rare in this low-risk group. Testing patients without bleeding risks resulted in over $850,000 in laboratory costs over the 10-year period. The cost to identify one abnormal INR was estimated at nearly $700,000.

The study suggests that abnormal INR and platelet counts are rare in patients without known bleeding risks undergoing image-guided biopsies. The authors propose that eliminating prebiopsy coagulation testing in this group could reduce healthcare costs. They suggest that testing is unnecessary for patients without predisposing conditions. The findings indicate that current protocols may be overly cautious for this population. The researchers suggest that cost savings could be achieved without compromising patient safety. The study does not claim that all prebiopsy testing is unnecessary. It does not propose that testing should be eliminated for patients with known bleeding risks. The authors suggest that institutions consider revising testing protocols for low-risk patients.