title: Sentinel node biopsy versus elective neck dissection. Which is more cost-effective? A prospective observational study.
abstract: OBJECTIVE
  The aim of this prospective not randomized observational study was to determine the costs and outcomes of sentinel lymph node biopsy (SNB) vs elective neck dissection (END) among patients with early oral squamous cell carcinoma (OSCC).
  
  
  METHODS
  Seventy-three consecutive patients were divided according to neck staging method. Patients took the decision themselves after receiving detailed information of both suggested treatment tools. False negative (FN) and negative predictive value (NPV) were assessed. Log-rank test was used to compare disease-free survival (DFS) and overall survival (OS). Only direct costs were analysed. Cost information derived from volumes for hospital stay, surgery and neck outcome were obtained from an internal database of tertiary health care center.
  
  
  RESULTS
  Thirty-two patients underwent SNB and 41 underwent an END (levels I-III). Average follow-up time was 48.2 months (range 7-80). Five neck recurrences were recorded in the SNB group (range 11-21). Seven neck recurrences occurred in the END group (range 9-16). No significant differences were found in DFS or OS. True negative patients in SNB group incurred in 42% less costs than END group. FN regardless of radiotherapy, was also lower in the SNB group. However, pN+ patients generated 23% more costs in the SNB group.
  
  
  CONCLUSIONS
  In this not randomized observational study with an average follow-up period of 48.2 months, SNB appear to confer less cost than END, with similar prognosis.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Donostia Hospital, San Sebastian, Spain. Electronic address: josue.hernando@gmail.com.
authors.forename: Josué
authors.initials: J
authors.lastname: Hernando
authors.affiliation: Oral and Maxillofacial Surgery, Private Practice, Oviedo, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Villarreal
authors.affiliation: Department of Surgery, Central Hospital, Oviedo, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Álvarez-Marcos
authors.affiliation: Department of Oral and Maxillofacial Surgery, Oviedo University, Central Hospital, Oviedo, Spain.
authors.forename: Luís
authors.initials: L
authors.lastname: García-Consuegra
authors.affiliation: Department of Oral and Maxillofacial Surgery, Oviedo University, Central Hospital, Oviedo, Spain.
authors.forename: Lorena
authors.initials: L
authors.lastname: Gallego
authors.affiliation: Department of Oral and Maxillofacial Surgery, Oviedo University, Central Hospital, Oviedo, Spain.
authors.forename: Luís
authors.initials: L
authors.lastname: Junquera
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D003362:Cost-Benefit Analysis; D017558:Elective Surgical Procedures / Q000191:economics; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000473:pathology / Q000601:surgery*; D037981:Neck Dissection / Q000191:economics*; D009364:Neoplasm Recurrence, Local; D011446:Prospective Studies; D021701:Sentinel Lymph Node Biopsy / Q000191:economics*; D013030:Spain
keywords: Cost; Elective neck dissection; Oral squamous cell carcinoma; Sentinel node biopsy