Margins in breast conserving surgery: The financial cost &amp; potential savings associated with the new margin guidelines

Singer, Lauren; Brown, Erin G.; Lanni, Thomas B.

doi:10.1016/j.breast.2016.04.007

Cited by 18 publications

(21 citation statements)

References 3 publications

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“…Only direct medical costs were reported; indirect costs (not directly accountable to the operation) and intangible costs (unquantifiable cost relating to an identifiable source) were not estimated in any of the reviewed literature. The source of cost estimates was hospital records in four studies and Centers for Medicare and Medicaid Services reimbursement data in three. Initial BCS and reoperation costs were in the range US $1234–11786 and $655–9136 respectively ( Table S2, supporting information).…”

Section: Resultsmentioning

confidence: 99%

“…The present health economic review highlights the heterogeneity and paucity of high‐quality studies reporting cost estimates of reoperations in breast surgery. Only nine studies have commented on reported costs of re‐excision in BCS, with two employing a predictive model to hypothesize the cost impact of re‐excision following BCS in the USA and Canada. Several studies contained minimal cost information, whereas others reported a range of costs for numerous variables that could not be collated accurately.…”

Section: Discussionmentioning

confidence: 99%

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Patient-level costs in margin re-excision for breast-conserving surgery

Grant

Al-Khudairi

John

et al. 2018

British Journal of Surgery

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Background: High rates of reoperation following breast-conserving surgery (BCS) for positive margins are associated with costs to healthcare providers. The aim was to assess the quality of evidence on reported re-excision costs and compare the direct patient-level costs between patients undergoing successful BCS versus reoperations after BCS. Methods: The study used data from women who had BCS with or without reoperation at a single institution between April 2015 and March 2016. A systematic review of health economic analysis in BCS was conducted and scored using the Quality of Health Economic Studies (QHES) instrument. Financial data were retrieved using the Patient-Level Information and Costing Systems (PLICS) for patients. Exchange rates used were: US $1 = £0⋅75, £1 = €1⋅14 and US $1 = €0⋅85. Results: The median QHES score was 47 (i.q.r. 32⋅5-79). Only two of nine studies scored in the upper QHES quartile (score at least 75). Costs of initial lumpectomy and reoperation were in the range US $1234-11786 and $655-9136 respectively. Over a 12-month interval, 153 patients had definitive BCS and 59 patients underwent reoperation. The median cost of reoperations after BCS (59 patients) was £4511 (range 1752-18 019), representing an additional £2136 per patient compared with BCS without reoperation (P < 0⋅001). Conclusion: The systematic review demonstrated variation in methodological approach to cost estimates and a paucity of high-quality cost estimate studies for reoperations. Extrapolating local PLICS data to a national level suggests that getting BCS right first time could result in substantial savings.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Patient-level costs in margin re-excision for breast-conserving surgery

Grant

Al-Khudairi

John

et al. 2018

British Journal of Surgery

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“…In addition to possible implications for local recurrence, the economic burden of re‐excisions in BCS is not insignificant; therefore, we must make certain these procedures are high‐yield. The average cost of BCS has been shown to be around $1,801.92 and may be up to $4,767 with multiple re‐excisions . Thus, while the MarginMarker kit adds approximately $130 to the initial procedure, it may ensure that re‐excisions are more likely to excise any residual disease that may exist.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative inking is superior to suture marking for specimen orientation in breast cancer

et al. 2019

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Margin status is an important indicator of residual disease after breast‐conserving surgery (BCS). Intraoperatively, surgeons orient specimens to aid assessment of margins and guide re‐excision of positive margins. We performed a retrospective review of BCS cases from 2013 to 2017 to compare the two specimen orientation methods: suture marking and intraoperative inking. Patients with ductal carcinoma in situ, T1/T2 invasive cancer treated with BCS were included. Rates of positive margins and residual disease at re‐excision were evaluated. 189 patients underwent BCS; 83 had suture marking, 103 had intraoperative inking and 3 had un‐oriented specimens. The incidence of positive margins was 29% (24 patients) in the suture marked group and 20% (21 patients) in the intraoperative inked group (P = .18). Among the 45 patients with positive margins, 60% of tumors were stage T1, 76% were node negative, 36% were palpable with median tumor size of 1.5 cm. Residual disease was identified on re‐excision in 21% of the suture marked specimens and 57% of intraoperative inked specimens (P = .028). The incidence of residual cancer at re‐excision for positive margins was higher for intraoperatively inked versus suture marked specimens. This finding suggests that intraoperative inking is more effective at guiding re‐excision of positive margins.

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“…Consequently, the rate of positive margins following partial mastectomy is unignorably high, resulting in significantly high rates of re-excision and delays in adjuvant care. This causes two major problems: an increase in the risk of cancer recurrence and an increase in the total treatment cost. ,, To achieve successful surgical treatment with a more effective and less time- and cost-consuming method, near-infrared (NIR) fluorescence image-guided surgery has been proposed and is gaining prominence . This imaging technique utilizes NIR fluorescent probes that emit in the NIR range, and these probes have become popular because of their high signal-to-noise ratio (“low-noise”) due to minimal intrinsic autofluorescence from tissues. , Among several NIR fluorescent agents, toxicity and nonspecific targeting of probes are generally major limitations in their clinical application.…”

Section: Introductionmentioning

confidence: 99%

Nontoxic Tumor-Targeting Optical Agents for Intraoperative Breast Tumor Imaging

et al. 2022

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Precise identification of the tumor margins during breast-conserving surgery (BCS) remains a challenge given the lack of visual discrepancy between malignant and surrounding normal tissues. Therefore, we developed a fluorescent imaging agent, ICG-p28, for intraoperative imaging guidance to better aid surgeons in achieving negative margins in BCS. Here, we determined the pharmacokinetics (PK), biodistribution, and preclinical toxicity of ICG-p28. The PK and biodistribution of ICG-p28 indicated rapid tissue uptake and localization at tumor lesions. There were no doserelated effect and no significant toxicity in any of the breast cancer and normal cell lines tested. Furthermore, ICG-p28 was evaluated in clinically relevant settings with transgenic mice that spontaneously developed invasive mammary tumors. Intraoperative imaging with ICG-p28 showed a significant reduction in the tumor recurrence rate. This simple, nontoxic, and cost-effective method can offer a new approach that enables surgeons to intraoperatively identify tumor margins and potentially improves overall outcomes by reducing recurrence rates.

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Margins in breast conserving surgery: The financial cost & potential savings associated with the new margin guidelines

Cited by 18 publications

References 3 publications

Patient-level costs in margin re-excision for breast-conserving surgery

Patient-level costs in margin re-excision for breast-conserving surgery

Intraoperative inking is superior to suture marking for specimen orientation in breast cancer

Nontoxic Tumor-Targeting Optical Agents for Intraoperative Breast Tumor Imaging

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