Skip to main content

Advertisement

SpringerLink
Log in

Cost-Effectiveness of Radioguided Occult Lesion Localization (ROLL) Versus Wire-Guided Localization (WGL) in Breast Conserving Surgery for Nonpalpable Breast Cancer: Results from a Randomized Controlled Multicenter Trial

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Accurate preoperative localization of nonpalpable breast cancer is essential to achieve complete resection. Radioguided occult lesion localization (ROLL) has been introduced as an alternative for wire-guided localization (WGL). Although efficacy of ROLL has been established in a randomized controlled trial, cost-effectiveness of ROLL compared with WGL is not yet known. The objective of this study was to determine whether ROLL has acceptable cost-effectiveness compared with WGL.

Methods

An economic evaluation was performed along with a randomized controlled trial (ClinicalTrials.gov, No. NCT00539474). Women (>18 years) with histologically proven nonpalpable breast cancer and eligible for breast conserving treatment with sentinel node procedure were randomized to ROLL (n = 162) or WGL (n = 152). Empirical data on direct medical costs were collected, and changes in quality of life were measured over a 6-month period. Bootstrapping was used to assess uncertainty in cost-effectiveness estimates, and sensitivity of the results to the missing data approach was investigated.

Results

In total, 314 patients with 316 invasive breast cancers were enrolled. On average ROLL required the same time as WGL for the surgical procedure (119 vs 118 min), resulted in a 7 % higher reinterventions risk, and 13 % more complications. Quality of life effects were similar (difference 0.00 QALYs 95 % CI (−0.04–0.05). Total costs were also similar for ROLL and WGL (+€26 per patient 95 % CI €−250–311).

Conclusion

ROLL is comparable to WGL with respect to both costs and quality of life effects as measured with the EQ5D and will therefore not lead to more cost-effective medical care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. NKR cijfers over kanker. 2011. Available: www.cijfersoverkanker.nl.

  2. Fleming FJ, Hill AD, McDermott EW, O’Doherty A, O’Higgins NJ, Quinn CM. Intraoperative margin assessment and re-excision rate in breast conserving surgery. Eur J Surg Oncol. 2004;30:233–7.

    Article  PubMed  CAS  Google Scholar 

  3. Burkholder HC, Witherspoon LE, Burns RP, Horn JS, Biderman MD. Breast surgery techniques: preoperative bracketing wire localization by surgeons. Am Surg. 2007;73:574–8; discussion 578–9.

    Google Scholar 

  4. Lovrics P, Cornacchi S, Vora R, Goldsmith C, Kahnamoui K. Systematic review of radio-guided surgery for nonpalpable breast cancer. Ann Surg Oncol. 2010;17:S181.

    Google Scholar 

  5. Lovrics PJ, Cornacchi SD, Farrokhyar F, Garnett A, Chen V, Franic S, et al. The relationship between surgical factors and margin status after breast-conservation surgery for early stage breast cancer. Am J Surg. 2009;197:740–6.

    Article  PubMed  Google Scholar 

  6. Postma EL, Witkamp AJ, van den Bosch MA, Verkooijen HM, van Hillegersberg R. Localization of nonpalpable breast lesions. Expert Rev Anticancer Ther. 2011;11:1295–302.

    Article  PubMed  Google Scholar 

  7. Dodd G, Fry K, Delany W. Pre-operative localization of occult carcinoma of the breast. In: Nealon TF Jr, editors. Management of the Patient with Cancer. Philadelphia: Saunders; 1965. p. 88–113.

    Google Scholar 

  8. Verkooijen HM, Peeters PH, Buskens E, Koot VC, Borel Rinkes IH, Mali WP, et al. Diagnostic accuracy of large-core needle biopsy for nonpalpable breast disease: a meta-analysis. Br J Cancer. 2000;82:1017–21.

    Article  PubMed  CAS  Google Scholar 

  9. Klimberg VS, Kepple J, Shafirstein G, Adkins L, Henry-Tillman R, Youssef E, et al. eRFA: excision followed by RFA-a new technique to improve local control in breast cancer. Ann Surg Oncol. 2006;13:1422–33.

    Article  PubMed  Google Scholar 

  10. Helvie MA, Ikeda DM, Adler DD. Localization and needle aspiration of breast lesions: complications in 370 cases. AJR Am J Roentgenol. 1991;157:711–4.

    Article  PubMed  CAS  Google Scholar 

  11. Azoury F, Sayad P, Rizk A. Thoracoscopic management of a pericardial migration of a breast biopsy localization wire. Ann Thorac Surg. 2009;87:1937–9.

    Article  PubMed  Google Scholar 

  12. Chadwick DR, Shorthouse AJ. Wire-directed localization biopsy of the breast: an audit of results and analysis of factors influencing therapeutic value in the treatment of breast cancer. Eur J Surg Oncol. 1997;23:128–33.

    Article  PubMed  CAS  Google Scholar 

  13. Seifi A, Axelrod H, Nascimento T, Salam Z, Karimi S, Avestimehr S, et al. Migration of guidewire after surgical breast biopsy: an unusual case report. Cardiovasc Intervent Radiol. 2009;32:1087–90.

    Article  PubMed  Google Scholar 

  14. Postma EL, Verkooijen HM, van Esser S, et al. Efficacy of ‘radioguided occult lesion localisation’ (ROLL) versus ‘wire-guided localisation’ (WGL) in breast conserving surgery for non-palpable breast cancer: a randomised controlled multicentre trial. Breast Cancer Res Treat. 2012;136:469–78.

    Article  PubMed  CAS  Google Scholar 

  15. van Esser S, Hobbelink MG, Peeters PH, Buskens E, van der Ploeg IM, Mali WP, et al. The efficacy of ‘radio guided occult lesion localization’ (ROLL) versus ‘wire-guided localization’ (WGL) in breast conserving surgery for non-palpable breast cancer: a randomized clinical trial—ROLL study. BMC Surg. 2008;8:9.

    Article  PubMed  Google Scholar 

  16. EuroQol—a new facility for the measurement of health-related quality of life. The EuroQol Group. Health Policy. 1990;16:199–208.

    Google Scholar 

  17. Donders AR, van der Heijden GJ, Stijnen T, Moons KG. Review: a gentle introduction to imputation of missing values. J Clin Epidemiol. 2006;59:1087–91.

    Article  PubMed  Google Scholar 

  18. van der Heijden GJ, Donders AR, Stijnen T, Moons KG. Imputation of missing values is superior to complete case analysis and the missing-indicator method in multivariable diagnostic research: a clinical example. J Clin Epidemiol. 2006:59:1102–9.

    Article  PubMed  Google Scholar 

  19. Burton A, Billingham LJ, Bryan S. Cost-effectiveness in clinical trials: using multiple imputation to deal with incomplete cost data. Clin Trials. 2007:;4:154–61.

    Article  PubMed  Google Scholar 

  20. van Hout BA, Al MJ, Gordon GS, Rutten FF. Costs, effects and C/E-ratios alongside a clinical trial. Health Econ. 1994;3:309–19.

    Article  PubMed  Google Scholar 

  21. Nadeem R, Chagla LS, Harris O, Desmond S, Thind R, Titterrell C, et al. Occult breast lesions: A comparison between radioguided occult lesion localisation (ROLL) vs. wire-guided lumpectomy (WGL). Breast. 2005;14:283–9.

    Article  PubMed  CAS  Google Scholar 

  22. Moreno M, Wiltgen JE, Bodanese B, Schmitt RL, Gutfilen B, da Fonseca LM. Radioguided breast surgery for occult lesion localization—correlation between two methods. J Exp Clin Cancer Res. 2008;27:29.

    Article  PubMed  Google Scholar 

  23. Ronka R, Krogerus L, Leppanen E, Von Smitten K, Leidenius M. Radio-guided occult lesion localization in patients undergoing breast-conserving surgery and sentinel node biopsy. Am J Surg. 2004;187:491–6.

    Article  PubMed  Google Scholar 

  24. Medina-Franco H, Abarca-Perez L, Garcia-Alvarez MN, Ulloa-Gomez JL, Romero-Trejo C, Sepulveda-Mendez J. Radioguided occult lesion localization (ROLL) versus wire-guided lumpectomy for non-palpable breast lesions: a randomized prospective evaluation. J Surg Oncol. 2008;97:108–11.

    Article  PubMed  Google Scholar 

  25. Zgajnar J, Hocevar M, Frkovic-Grazio S, Hertl K, Schwarzbartl-Pevec A, Schweiger E, et al. Radioguided occult lesion localization (ROLL) of the nonpalpable breast lesions. Neoplasma. 2004;51:385–9.

    PubMed  CAS  Google Scholar 

  26. Lovrics PJ, Goldsmith CH, Hodgson N, McCready D, Gohla G, Boylan C, et al. A multicentered, randomized, controlled trial comparing radioguided seed localization to standard wire localization for nonpalpable, invasive and in situ breast carcinomas. Ann Surg Oncol. 2011;18:3407–14.

    Article  PubMed  Google Scholar 

  27. Jakub JW, Gray RJ, Degnim AC, Boughey JC, Gardner M, Cox CE. Current status of radioactive seed for localization of non palpable breast lesions. Am J Surg. 2010;199:522–8.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands

    E. L. Postma MD, A. J. Witkamp MD & R. van Hillegersberg MD

  2. Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands

    H. Koffijberg PhD

  3. Imaging Division, University Medical Centre Utrecht, Utrecht, The Netherlands

    H. M. Verkooijen MD & M. A. A. J. van den Bosch MD

Authors
  1. E. L. Postma MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H. Koffijberg PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. H. M. Verkooijen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. J. Witkamp MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. A. A. J. van den Bosch MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. R. van Hillegersberg MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to E. L. Postma MD.

Additional information

This study is conducted for the ROLL Study Group. The study group members are listed in Appendix.

Appendix

Appendix

Study Group Members

Amphia Hospital: Breda: G. Van der Schelling, A. Rijken, J. Nuytinck, E. Luiten, E. Tetteroo, H. Dijkstra, P. Raaymakers, P. Van Noorden, J. Baas, D. Vos, J. Wijsman; St. Antonius Hospital, Nieuwegein: R. Koelemij, E. Theunissen, S. van Esser, A. van Wieringen, P. Go, J. Lavalaye, T. Bollen, M. Appelman; UMC Utrecht, Utrecht: E.L. Postma, L. Glaap, A.J. Witkamp, I.H.M Borel Rinkes, R. van Hillegersberg, M. Hobbelink, A. Fernandez, G. Stapper, M. van den Bosch, W. Mali, H. Verkooijen, S.M. Willems, P.J. van Diest; Maasstad ziekenhuis, Rotterdam: C. Contant.

See Table 5.

Table 5 Detailed costs
Full size table

Rights and permissions

Reprints and permissions

About this article

Cite this article

Postma, E.L., Koffijberg, H., Verkooijen, H.M. et al. Cost-Effectiveness of Radioguided Occult Lesion Localization (ROLL) Versus Wire-Guided Localization (WGL) in Breast Conserving Surgery for Nonpalpable Breast Cancer: Results from a Randomized Controlled Multicenter Trial. Ann Surg Oncol 20, 2219–2226 (2013). https://doi.org/10.1245/s10434-013-2888-7

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-013-2888-7

Keywords

Search

Navigation