The impact of sentinel node biopsy and axillary staging strategy on hospital costs

Rönkä, R.; Smitten, Karl von; Sintonen, Harri; Kotomäki, T; Krogerus, Leena; Leppänen, Esa; Leidenius, Marjut

doi:10.1093/annonc/mdh019

Cited by 32 publications

(10 citation statements)

References 9 publications

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“…Rónká et al showed that, with respect to hospital costs, FS analysis seems to be worthwhile as long as the false negative rate does not exceed 35% [14]. This is due to the lower costs of a shorter hospital stay and the association with a decrease in long-term postoperative morbidity.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Benefit of Routine Intraoperative Frozen Section Analysis of Sentinel Lymph Nodes in Breast Cancer

et al. 2013

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Aims. Intraoperative analysis of the sentinel lymph node (SLN) by frozen section (FS) allows for immediate axillary lymph node dissection (ALND) in case of metastatic disease in patients with breast cancer. The aim of this study is to evaluate the benefit of intraoperative FS, with regard to false negative rate (FNR) and influence on operation time. Materials and Methods. Intraoperative analysis of the SLN by FS was performed on 628 patients between January 2005 and October 2009. Patients were retrospectively studied. Results. FS accurately predicted axillary status in 525 patients (83.6%). There were 78 true positive findings (12.4%), of which there are 66 macrometastases (84.6%), 2 false positive findings (0.3%), and 101 false negative findings (16.1%), of which there are 65 micrometastases and isolated tumour cells (64.4%) resulting in an FNR of 56.4%. Additional operation time of a secondary ALND after wide local excision and SLNB is 17 minutes, in case of ablative surgery 35 minutes. The SLN was negative in 449 patients (71.5%), making their scheduled operation time unnecessary. Conclusions. FS was associated with a high false negative rate (FNR) in our population, and the use of telepathology caused an increase in this rate. Only 12.4% of the patients benefited from intraoperative FS, as secondary ALND could be avoided, so FS may be indicated for a selected group of patients.

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Section: Discussionmentioning

confidence: 99%

Evaluation of the Benefit of Routine Intraoperative Frozen Section Analysis of Sentinel Lymph Nodes in Breast Cancer

et al. 2013

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“…Moreover, in addition to increasing the potential for patient morbidity, there is added financial expense in the staged approach. 7 Completion ALND following autologous reconstruction may pose certain risks toward flap viability. However, a latissimus dorsi myocutaneous flap is not typically used as a primary form of reconstruction (0.5% of the cases in this series), and free tissue transfer is more commonly dependent on internal mammary vessels rather than the thoracodorsal pedicle that may be compromised in a secondary axillary dissection after reconstruction.…”

Section: Annals Of Plastic Surgery • Volume 66 Number 5 May 2011mentioning

confidence: 99%

“…[5][6][7][8] It has been previously reported from this institution that performing SLNB at the time of definitive surgery had minimal impact on the intraoperative reconstructive plan. 9 The purpose of this study was to evaluate both the immediate and long-term outcomes in women who underwent SLNB in the same setting as mastectomy and IBR.…”

mentioning

confidence: 94%

Outcomes of Immediate Breast Reconstruction in Patients Undergoing Single-Stage Sentinel Lymph Node Biopsy and Mastectomy

Wood¹,

Levine²,

Marks³

et al. 2011

Annals of Plastic Surgery

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The ability to more definitively plan breast reconstruction after obtaining final histologic analysis of the sentinel lymph node biopsy (SLNB) has led several groups to advocate a staged approach to SLNB and mastectomy. Certain disadvantages are inherent in that approach, including increased patient morbidity, financial expense, and inconvenience. A retrospective review was conducted 195 procedures in which mastectomy and SLNB were performed in a single stage with immediate breast reconstruction (IBR) over a 10-year period. Long-term outcomes were analyzed within the context of patient characteristics and SLNB results. Intraoperative SLNB analysis was found to be a reliable method for planning IBR, as there were no patients noted to have untoward sequelae as a result of a false-negative SLNB, and the probability of postmastectomy radiation therapy was predictable based on the intraoperative SLNB results. We advocate that SLNB be performed in a single stage with mastectomy and IBR.

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“…Lymphatic mapping with sentinel lymph node (SLN) biopsy has been introduced as an alternative to elective LN dissection and has gained rapid acceptance because it allows improved accuracy and decreased patient morbidity for regional cancer staging (4, 5). However, SLN biopsy still has major limitations.…”

Section: Introductionmentioning

confidence: 99%

Sentinel Lymph Node Biopsy Revisited: Ultrasound-Guided Photoacoustic Detection of Micrometastases Using Molecularly Targeted Plasmonic Nanosensors

et al. 2014

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Metastases rather than primary tumors are responsible for killing most cancer patients. Cancer cells often invade regional lymph nodes (LN) before colonizing other parts of the body. However, due to the low sensitivity and specificity of current imaging methods to detect localized nodal spread, an invasive surgical procedure - sentinel lymph node biopsy - is generally employed to identify metastatic cancer cells. Here we introduce a new approach for more sensitive in vivo detection of lymph node micrometastases, based on the use of ultrasound-guided spectroscopic photoacoustic (sPA) imaging of molecularly-activated plasmonic nanosensors (MAPS). Using a metastatic murine model of oral squamous cell carcinoma, we showed that MAPS targeted to the EGFR shifted their optical absorption spectrum to the red-near-infrared region after specific interactions with nodal metastatic cells, enabling their non-invasive detection by sPA. Notably, LN metastases as small as 50 μm were detected at centimeter-depth range with high sensitivity and specificity. Large sPA signals appeared in metastatic LN within 30 minutes of MAPS injection, in support of the clinical utility of this method. Our findings offer a rapid and effective tool to non-invasively identify micrometastases as an alternate to sentinal node biopsy analysis.

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The impact of sentinel node biopsy and axillary staging strategy on hospital costs

Abstract: SNB seems to be associated with higher hospital costs than diagnostic ALND. Frozen section diagnosis seems to be worthwhile as long as the false negative rate is <35%.

Cited by 32 publications

References 9 publications

Evaluation of the Benefit of Routine Intraoperative Frozen Section Analysis of Sentinel Lymph Nodes in Breast Cancer

Evaluation of the Benefit of Routine Intraoperative Frozen Section Analysis of Sentinel Lymph Nodes in Breast Cancer

Outcomes of Immediate Breast Reconstruction in Patients Undergoing Single-Stage Sentinel Lymph Node Biopsy and Mastectomy

Sentinel Lymph Node Biopsy Revisited: Ultrasound-Guided Photoacoustic Detection of Micrometastases Using Molecularly Targeted Plasmonic Nanosensors

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