title: Outcome and Cost Effectiveness of Ultrasonographically Guided Surgical Clip Placement for Tumor Localization in Patients undergoing Neo-adjuvant Chemotherapy for Breast Cancer.
abstract: BACKGROUND
  To determine the outcome and cost saving by placing ultrasound guided surgical clips for tumor localization in patients undergoing neo-adjuvant chemotherapy for breast cancer.
  
  
  METHODS
  This retrospective cross sectional analytical study was conducted at the Department of Diagnostic Radiology, Aga Khan University Hospital, Karachi, Pakistan from January to December 2014. A sample of 25 women fulfilling our selection criteria was taken. All patients came to our department for ultrasound guided core biopsy of suspicious breast lesions and clip placement in the index lesion prior to neo-adjuvant chemotherapy. All the selected patients had biopsy proven breast cancer.
  
  
  RESULTS
  The mean age was 45 ± 11.6 years. There were no complications seen after clip placement in terms of clip migration or hemorrhage. The cost of commercially available markers was approximately PKR 9,000 (US$ 90) and that of the surgical clip was PKR 900 (US$ 9). The cost of surgical clips in 25 patients was PKR 22,500 (US$ 225), when compared to the commercially available markers which may have incurred a cost of PKR 225,000 (US$ 2,250). The total cost saving for 25 patients was PKR 202,500 (US$ 2, 025), making it PKR 8100 (US$ 81) per patient.
  
  
  CONCLUSIONS
  The results of our study show that ultrasound guided surgical clip placement in index lesions prior to neo-adjuvant therapy is a safe and cost effective method to identify tumor bed and response to treatment for further management.
authors.affiliation: Department of Radiology, Aga Khan University Hospital, Karachi Pakistan E-mail : imrana.masroor@aku.edu.
authors.forename: Imrana
authors.initials: I
authors.lastname: Masroor
authors.forename: Sana
authors.initials: S
authors.lastname: Zeeshan
authors.forename: Shaista
authors.initials: S
authors.lastname: Afzal
authors.forename: Saira Naz
authors.initials: SN
authors.lastname: Sufian
authors.forename: Madeeha
authors.initials: M
authors.lastname: Ali
authors.forename: Shaista
authors.initials: S
authors.lastname: Khan
authors.forename: Khabir
authors.initials: K
authors.lastname: Ahmad
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics* / Q000627:therapeutic use; D001707:Biopsy, Needle; D001943:Breast Neoplasms / Q000188:drug therapy / Q000191:economics* / Q000473:pathology / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D061705:Image-Guided Biopsy / Q000191:economics*; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000191:economics*; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D013525:Surgical Instruments / Q000191:economics*; D016217:Ultrasonography, Mammary / Q000191:economics*