The impact of sentinel node biopsy and axillary staging strategy on hospital costs.
BACKGROUND
The aim of the study was to evaluate total hospital costs of three different sentinel node biopsy (SNB) protocols compared to those of diagnostic axillary lymph node dissection (ALND).


METHODS
The study included 237 consecutive breast cancer patients who underwent SNB with frozen section diagnosis. The sequence of the treatment procedures for each patient was recorded. The sequences of treatment procedures for the same patients were evaluated using three hypothetical scenarios: diagnostic ALND, SNB without frozen section diagnosis and SNB as day case surgery prior to the breast operation. The total hospital costs were calculated in all protocols.


RESULTS
The hospital costs per patient were 3750euro;. The hospital costs per patient would have been 3020euro; when using the ALND model, 4087euro; had the frozen section not been applied and 4573euro; using 'SNB as day case surgery' model. The costs with or without frozen section diagnosis would have been equal with a threshold false negative rate of 35%.


CONCLUSIONS
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%.
Rönkä
R
R
Breast Surgery Unit, Maria Hospital, Helsinki University Hospital, Helsinki, Finland. ritta.ronka@pp.fimnet.fi
Smitten
K v
Kv
Sintonen
H
H
Kotomäki
T
T
Krogerus
L
L
Leppänen
E
E
Leidenius
M
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000191:economics / Q000473:pathology* / Q000601:surgery; D002277:Carcinoma / Q000191:economics / Q000473:pathology* / Q000601:surgery; D003663:Decision Trees; D005260:Female; D005387:Finland; D017721:Hospital Costs; D006785:Hospitals, University / Q000191:economics; D006801:Humans; D008197:Lymph Node Excision / Q000191:economics*; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D009367:Neoplasm Staging / Q000191:economics*; D011379:Prognosis; D011446:Prospective Studies; D021701:Sentinel Lymph Node Biopsy / Q000191:economics*