title: The SAVE review: sonographic analysis versus excision for axillary staging in breast cancer.
abstract: BACKGROUND
  Health care reform goals involve more cost-effective methods of delivering health care. The cost-effectiveness of axillary ultrasound-guided core needle biopsy (AUS-CNB) was compared with sentinel lymph node biopsy (SLNB) when evaluating the status of the axilla in operable invasive breast cancer.
  
  
  METHODS
  We performed an IRB-approved retrospective review of patients undergoing ultrasound of the axilla plus core needle biopsy at our institution from 2007 to 2012. An accuracy of technique and cost analysis (TreeAge Pro 2009) of AUS-CNB vs SLNB was conducted.
  
  
  RESULTS
  The cohort of 95 patients was divided into 2 groups: clinically positive (CP) (32%) and negative (CN) (68%) axilla. In the CP group, 83% had a suspicious AUS, of which 90% were positive. In the CN group, AUS was suspicious in 70%, with a positive biopsy in 59%. The sensitivity and specificity of AUS-CNB were 90% (95% CI 84.8% to 98.8%) and 100% (95% CI 27% to 59.1%), respectively. Cost estimates comparing AUS-CNB with SLNB demonstrated a cost saving of $236,517 in the CP axilla and $248,490 in the CN axilla, for a total cost savings of $485,007.
  
  
  CONCLUSIONS
  Axillary ultrasound-guided core needle biopsy is a sensitive, diagnostic, surgeon-performed procedure. It is time-saving, cost-efficient, and less invasive, making it a viable option when evaluating the status of the axilla in invasive breast cancer or staging before neoadjuvant chemotherapy.
authors: Department of Surgery, the University of Arkansas for Medical Sciences, Little Rock, AR; Winthrop P Rockefeller Cancer Institute, the University of Arkansas for Medical Sciences, Little Rock, AR. Electronic address: henryrondas@uams.edu.
authors: Ronda
authors: R
authors: Henry-Tillman
authors: Department of Surgery, the University of Arkansas for Medical Sciences, Little Rock, AR; Winthrop P Rockefeller Cancer Institute, the University of Arkansas for Medical Sciences, Little Rock, AR.
authors: Katherine
authors: K
authors: Glover-Collins
authors: Winthrop P Rockefeller Cancer Institute, the University of Arkansas for Medical Sciences, Little Rock, AR.
authors: Michael
authors: M
authors: Preston
authors: Department of Surgery, the University of Arkansas for Medical Sciences, Little Rock, AR; Winthrop P Rockefeller Cancer Institute, the University of Arkansas for Medical Sciences, Little Rock, AR.
authors: Kristalyn
authors: K
authors: Gallagher
authors: Winthrop P Rockefeller Cancer Institute, the University of Arkansas for Medical Sciences, Little Rock, AR.
authors: Evan
authors: E
authors: Tummel
authors: Department of Surgery, the University of Arkansas for Medical Sciences, Little Rock, AR; Winthrop P Rockefeller Cancer Institute, the University of Arkansas for Medical Sciences, Little Rock, AR.
authors: Yara V
authors: YV
authors: Robertson
authors: Department of Surgery, the University of Arkansas for Medical Sciences, Little Rock, AR; Winthrop P Rockefeller Cancer Institute, the University of Arkansas for Medical Sciences, Little Rock, AR.
authors: Daniela
authors: D
authors: Ochoa
authors: Department of Pathology, the University of Arkansas for Medical Sciences, Little Rock, AR.
authors: Soheila
authors: S
authors: Korourian
authors: Department of Surgery, the University of Arkansas for Medical Sciences, Little Rock, AR; Winthrop P Rockefeller Cancer Institute, the University of Arkansas for Medical Sciences, Little Rock, AR.
authors: Kent
authors: K
authors: Westbrook
authors: Department of Surgery, the University of Arkansas for Medical Sciences, Little Rock, AR; Department of Pathology, the University of Arkansas for Medical Sciences, Little Rock, AR; Winthrop P Rockefeller Cancer Institute, the University of Arkansas for Medical Sciences, Little Rock, AR.
authors: V Suzanne
authors: VS
authors: Klimberg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001707:Biopsy, Needle / Q000379:methods*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D016217:Ultrasonography, Mammary / Q000379:methods*