title: Cost comparison of axillary sentinel lymph node detection and axillary lymphadenectomy in early breast cancer. A national study based on a prospective multi-institutional series of 985 patients 'on behalf of the Group of Surgeons from the French Unicancer Federation'.
abstract: BACKGROUND
  Our objective was to assess the global cost of the sentinel lymph node detection [axillary sentinel lymph node detection (ASLND)] compared with standard axillary lymphadenectomy [axillary lymph node dissection (ALND)] for early breast cancer patients.
  
  
  METHODS
  We conducted a prospective, multi-institutional, observational, cost comparative analysis. Cost calculations were realized with the micro-costing method from the diagnosis until 1 month after the last surgery.
  
  
  RESULTS
  Eight hundred and thirty nine patients were included in the ASLND group and 146 in the ALND group. The cost generated for a patient with an ASLND, with one preoperative scintigraphy, a combined method for sentinel node detection, an intraoperative pathological analysis without lymphadenectomy, was lower than the cost generated for a patient with lymphadenectomy [€ 2947 (σ = 580) versus € 3331 (σ = 902); P = 0.0001].
  
  
  CONCLUSIONS
  ASLND, involving expensive techniques, was finally less expensive than ALND. The length of hospital stay was the cost driver of these procedures. The current observational study points the heterogeneous practices for this validated and largely diffused technique. Several technical choices have an impact on the cost of ASLND, as intraoperative analysis allowing to reduce rehospitalization rate for secondary lymphadenectomy or preoperative scintigraphy, suggesting possible savings on hospital resources.
authors: Surgical Department, Institut de Cancérologie de l'Ouest-Center Gauducheau, Nantes. Electronic address: jm-classe@nantes.fnclcc.fr.
authors: J M
authors: JM
authors: Classe
authors: Medico economic unit, Institut Curie, Paris.
authors: S
authors: S
authors: Baffert
authors: Pathology Department, Institut Curie, Paris.
authors: B
authors: B
authors: Sigal-Zafrani
authors: Medico economic unit, Institut Curie, Paris.
authors: M
authors: M
authors: Fall
authors: Nuclear medicine Department, Institut de Cancérologie de l'Ouest-Center Gauducheau, Nantes.
authors: C
authors: C
authors: Rousseau
authors: Surgical Department, Institut Curie, Paris.
authors: S
authors: S
authors: Alran
authors: Surgical Department, Center Val d'Aurel Montpellier.
authors: P
authors: P
authors: Rouanet
authors: Surgical Department, Center René Huguenin, Saint Cloud.
authors: C
authors: C
authors: Belichard
authors: Surgical Department, Center Léon Bérard, Lyon.
authors: H
authors: H
authors: Mignotte
authors: Surgical Department, Institut Claudius Regaud, Toulouse.
authors: G
authors: G
authors: Ferron
authors: Surgical Department, Center Alexis Vautrin, Nancy.
authors: F
authors: F
authors: Marchal
authors: Surgical Department, Center Oscar Lambret, Lille.
authors: S
authors: S
authors: Giard
authors: Surgical Department, Center Bergonié, Bordeaux.
authors: C
authors: C
authors: Tunon de Lara
authors: Surgical Department, Center Jean Perrin, Clermont Ferrand.
authors: G
authors: G
authors: Le Bouedec
authors: Surgical Department, Center Georges François Leclerc, Dijon.
authors: J
authors: J
authors: Cuisenier
authors: Surgical Department, Center Jean Godinot, Reims.
authors: R
authors: R
authors: Werner
authors: Surgical Department, Center Georges Lacassagne, Nice.
authors: I
authors: I
authors: Raoust
authors: Surgical Department, Center Paul Strauss, Strasbourg.
authors: J-F
authors: JF
authors: Rodier
authors: Medico economic unit, Institut Curie, Paris; Surgical Department, Institut Curie, Paris.
authors: F
authors: F
authors: Laki
authors: Surgical Department, Center Val d'Aurel Montpellier.
authors: P-E
authors: PE
authors: Colombo
authors: Surgical Department, Center René Huguenin, Saint Cloud.
authors: S
authors: S
authors: Lasry
authors: Surgical Department, Center Léon Bérard, Lyon.
authors: C
authors: C
authors: Faure
authors: Surgical Department, Institut Claudius Regaud, Toulouse.
authors: H
authors: H
authors: Charitansky
authors: Surgical Department, Center Alexis Vautrin, Nancy.
authors: J-B
authors: JB
authors: Olivier
authors: Surgical Department, Center Oscar Lambret, Lille.
authors: M-P
authors: MP
authors: Chauvet
authors: Surgical Department, Center Bergonié, Bordeaux.
authors: E
authors: E
authors: Bussières
authors: Surgical Department, Center Jean Perrin, Clermont Ferrand.
authors: P
authors: P
authors: Gimbergues
authors: Surgical Department, Center Georges Lacassagne, Nice.
authors: B
authors: B
authors: Flipo
authors: Surgical Department, Institut Paoli Calmette Marseille, France.
authors: G
authors: G
authors: Houvenaeghel
authors: Surgical Department, Institut de Cancérologie de l'Ouest-Center Gauducheau, Nantes.
authors: F
authors: F
authors: Dravet
authors: Medico economic unit, Institut Curie, Paris.
authors: A
authors: A
authors: Livartowski
mesh_terms: D000368:Aged; D000465:Algorithms; D001365:Axilla / Q000473:pathology; D001943:Breast Neoplasms / Q000175:diagnosis / Q000191:economics* / Q000473:pathology* / Q000601:surgery; D002277:Carcinoma / Q000175:diagnosis / Q000191:economics* / Q000473:pathology* / Q000601:surgery; D003365:Costs and Cost Analysis; D018450:Disease Progression; D005260:Female; D005602:France; D013502:General Surgery / Q000458:organization & administration; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008197:Lymph Node Excision / Q000191:economics* / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis / Q000175:diagnosis; D008495:Medical Oncology / Q000458:organization & administration; D008875:Middle Aged; D009367:Neoplasm Staging / Q000191:economics; D011446:Prospective Studies; D021701:Sentinel Lymph Node Biopsy / Q000191:economics*; D012955:Societies, Medical