title: Intraoperative immunohistochemistry staining of sentinel nodes in breast cancer: clinical and economical implications.
abstract: The study aimed to evaluate intraoperative immunohistochemistry (IHC) staining of sentinel nodes in primary breast cancer surgery. We analysed retrospectively 1209 consecutive sentinel node procedures and compared the rate of late positive metastases in sentinel node biopsy (SNB) and the duration of the surgical procedures before (n=706) and after (n=503) introducing intraoperative IHC on frozen section. We also did a cost analysis. Intraoperative IHC staining led to a lowering of the late positive SNB rate. Introducing IHC gave a decrease in the late positive rate from 93 to 52% (p<0.0001) for isolated tumour cell metastasis, from 56 to 36.4% (p<0.02) for micrometastasis, and from 16 to 5% (p<0.01) for macrometastasis. The surgical procedures were slightly prolonged for lumpectomies but not for mastectomies after introducing intraoperative IHC staining. The cost analysis showed an overall cost saving of approximately 40%. In conclusion, intraoperative IHC staining of the SNB lowered the late positive rate and gave an overall cost saving.
authors.affiliation: Department of Breast Surgery, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, DK-2730 Herlev, Denmark. mariannehu@m5.stud.ku.dk
authors.forename: Marianne
authors.initials: M
authors.lastname: Holm
authors.forename: Birgitte
authors.initials: B
authors.lastname: Paaschburg
authors.forename: Eva
authors.initials: E
authors.lastname: Balslev
authors.forename: Christen Kirk
authors.initials: CK
authors.lastname: Axelsson
authors.forename: Gro Linno
authors.initials: GL
authors.lastname: Willemoe
authors.forename: Henrik Lavlund
authors.initials: HL
authors.lastname: Flyger
mesh_terms: D001943:Breast Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000601:surgery*; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D005629:Frozen Sections / Q000191:economics; D006801:Humans; D007150:Immunohistochemistry / Q000191:economics*; D007430:Intraoperative Care / Q000191:economics*; D008408:Mastectomy; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy / Q000191:economics; D016896:Treatment Outcome