title: Value analysis of postoperative staging imaging for asymptomatic, early-stage breast cancer: implications of clinical variation on utility and cost.
abstract: BACKGROUND
  Routine staging imaging for early-stage breast cancer is not recommended. Despite this, there is clinical practice variation with imaging studies obtained for asymptomatic patients with a positive sentinel node (SN+). We characterize the utility, cost, and clinical implications of imaging studies obtained in asymptomatic SN+ patients.
  
  
  METHODS
  A retrospective review was performed of asymptomatic, clinically node-negative patients who were found to have a positive sentinel node after surgery. The type of imaging, subsequent tests/interventions, frequency of additional malignancy detected, and costs were recorded.
  
  
  RESULTS
  From April 2009 to April 2013, a total of 50 of 113 (44%) asymptomatic patients underwent staging imaging for a positive sentinel node; 11 (22%) patients had at least 1 subsequent imaging study or diagnostic intervention. No instance of metastatic breast cancer was identified, with a total cost of imaging calculated at $116,905.
  
  
  CONCLUSIONS
  Staging imaging for asymptomatic SN+ breast cancer demonstrates clinical variation. These tests were associated with low utility, increased costs, and frequent false positives leading to subsequent testing/intervention. Evidence-based standardization may help increase quality by decreasing unnecessary variation and cost.
authors.affiliation: Department of Surgery, University of Vermont, 89 Beaumont Avenue, Given Building, Burlington, VT, 05405, USA.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Pellet
authors.affiliation: Department of Surgery, University of Vermont, 89 Beaumont Avenue, Given Building, Burlington, VT, 05405, USA.
authors.forename: Mujde Z
authors.initials: MZ
authors.lastname: Erten
authors.affiliation: Department of Surgery, University of Vermont, 89 Beaumont Avenue, Given Building, Burlington, VT, 05405, USA. Electronic address: ted.james@uvm.edu.
authors.forename: Ted A
authors.initials: TA
authors.lastname: James
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D003952:Diagnostic Imaging / Q000191:economics* / Q000379:methods*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging / Q000191:economics / Q000706:statistics & numerical data; D008408:Mastectomy / Q000009:adverse effects / Q000379:methods; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography / Q000191:economics / Q000706:statistics & numerical data; D011182:Postoperative Care; D012189:Retrospective Studies; D000071036:Sentinel Lymph Node / Q000473:pathology*; D014057:Tomography, X-Ray Computed / Q000191:economics / Q000706:statistics & numerical data; D018608:Ultrasonography, Doppler / Q000191:economics; D014481:United States
keywords: Breast cancer; Clinical variation; Cost; Imaging; Quality; Value