title: Sentinel lymph node intraoperative imprint cytology in patients with breast cancer-costly or cost effective?
abstract: BACKGROUND
  Sentinel lymph node (SLN) biopsy is now standard of care for breast cancer patients. Intraoperative imprint cytology (IIC) provides results to the surgeon, which may lead to a lymphadenectomy under the same anesthetic when it is positive for metastases. Thus, a positive IIC can spare the patient a second operation and the charges associated with it. The aim of this study is to assess the cost effectiveness of IIC in breast cancer patients.
  
  
  METHODS
  This study evaluated 98 patients who underwent a SLN biopsy between July 2008 and May 2009. The patients were divided into 1 of 3 groups based on the results of IIC and permanent sections: (1) true-negative (TN) IIC, (2) true-positive (TP) IIC, and (3) false-negative (FN) IIC. Total charges for each patient were extracted retrospectively, and nonparametric tests assessed differences in the charges between the three groups.
  
  
  RESULTS
  The median total charges per patient for each population were the following: (1) $14,764.62, (2) $19,025.89, and (3) $29,750.64 (P < 0.05). A difference of more than $10,000 exists in total charges per patient between the node-positive population who did not benefit from IIC (FN) and the node-positive population who did benefit from IIC (TP).
  
  
  CONCLUSIONS
  IIC is a cost-effective evaluation of breast cancer patients. The difference in total charges between the FN and TP groups outweighs the cost of the IIC. In addition to the reduced costs incurred by the patient and the hospital, IIC spares the patient the psychological and physical stress of a second operation.
authors.affiliation: Department of Surgical Oncology, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
authors.forename: Jan P
authors.initials: JP
authors.lastname: Kamiński
authors.forename: Doug
authors.initials: D
authors.lastname: Case
authors.forename: Marissa
authors.initials: M
authors.lastname: Howard-McNatt
authors.forename: Kim R
authors.initials: KR
authors.lastname: Geisinger
authors.forename: Edward A
authors.initials: EA
authors.lastname: Levine
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D003362:Cost-Benefit Analysis; D005260:Female; D016591:Histocytological Preparation Techniques / Q000191:economics*; D006801:Humans; D007430:Intraoperative Care; D008198:Lymph Nodes / Q000473:pathology*; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy / Q000191:economics*