title: Preoperative Sentinel Node Mapping in Sentinel Node Biopsy in Early Breast Cancers - Is It Cost-Effective?
abstract: Sentinel lymph node (SLN) biopsy is currently the gold standard of treatment in early breast cancers. Identification of SLNs by preoperative scintigraphy has been carried out to improve the detection of SLNs intraoperatively, but the evidence of its cost-effectiveness is lacking. Here, we analyze the cost-effectiveness of the utilization of scintigraphy in detection of SLNs.
  
  
  
  Clinical and operative details were retrieved from a prospectively maintained database. The resources and cost data from each patient who had undergone SLN biopsy with preoperative scintigraphy were retrieved.
  
  
  
  From January 2008 to December 2012, 400 patients underwent SLN biopsy for breast cancer. A total of 329 had preoperative SLN mapping with scintigraphy, Baseline patient demographic data for both arms were comparable. The relapse and recurrence rate of both arms were not statistically different. The detection rate of SLNs of both arms was the same (100%), and there were no grade 2 or above lymphedema in both groups of patients. However, the cost of each patient undergoing SLN mapping was USD $345.8.
  
  
  
  Preoperative SLN mapping does not improve the SLN detection rate. In addition, it does not affect the surgical outcomes in terms of complication, local relapse, and recurrence. The use of preoperative SLN mapping is no longer cost-effective.
authors.affiliation: Division of Breast Surgery, Department of Surgery, Queen Mary Hospital, Hong Kong; Department of Surgery, The University of Hong Kong, Hong Kong.
authors.forename: Michael
authors.initials: M
authors.lastname: Co
authors.affiliation: Division of Breast Surgery, Department of Surgery, Queen Mary Hospital, Hong Kong; Department of Surgery, The University of Hong Kong, Hong Kong. Electronic address: avakwong@hku.hk.
authors.forename: Ava
authors.initials: A
authors.lastname: Kwong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D011300:Preoperative Care / Q000191:economics / Q000379:methods*; D011877:Radionuclide Imaging / Q000191:economics; D012189:Retrospective Studies; D000071036:Sentinel Lymph Node / Q000000981:diagnostic imaging* / Q000473:pathology; D021701:Sentinel Lymph Node Biopsy / Q000191:economics / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Breast cancer; Cost effective; Scintigraphy; Sentinel lymph node; Sentinel node mapping