There are several obstacles to the availability of stereotactic core biopsy. Though the stereotactic procedure is less expensive than a needle-localization biopsy, the initial investment in stereotactic equipment is expensive. Some HMOs and referred provider plans are happy with the stereotactic procedure because it lowers their biopsy costs. Low reimbursement rates by some managed care insurers, Medicare, and Medicaid further discourage the use of stereotactic core biopsy. Attach-on equipment allows the provider to alternate between regular mammograms and stereotactic core biopsy.
Critics say that the attach-on equipment has several disadvantages.
First, the arrangement does not give as much room for the practitioner to conduct the biopsy procedure. Second, because careful calibration is required each time the stereotactic equipment is put into place, the reliability of the biopsy is reduced. Further, stress, fatigue, moving, and fainting are more frequent when attach-on equipment is used, in part because the woman can see more of the procedure. In contrast, when a stand-alone unit is used, the woman cannot see the procedure since it takes place under the examination table. Another obstacle is turf battles between specialists, which lead to resistance from some physicians.