Skip to main content
SpringerLink
Log in

Cost/Accuracy Ratio Analysis in Breast Cancer Patients Undergoing Ultrasound-Guided Fine-Needle Aspiration Cytology, Sentinel Node Biopsy, and Frozen Section of Node

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

We evaluated the effectiveness and the cost of axillary staging in breast cancer patients by ultrasound-guided fine-needle aspiration cytology (US-FNAC), sentinel node biopsy (SNB), and frozen sections of the sentinel node to achieve the target of the highest number of immediate axillary dissections. From January 2003 through October 2005, a total of 404 consecutive eligible breast cancer patients underwent US-FNAC of suspicious axillary lymph nodes. If tumor cells were found, immediate axillary dissection was proposed (33% of node-positive cases). If US or cytology was negative, SNB was performed. Frozen sections of the sentinel node allowed immediate axillary dissection in 31% of node-positive cases. The remaining 36% underwent delayed axillary dissection. We compared our policy with clinical evaluation of the axilla, showing better specificity of US-FNAC, the cost balanced by a 12% reduction of SNBs, and a marked reduction of unnecessary axillary dissections resulting from false-positive clinical staging. Moreover, the comparison between our policy and permanent histology of the sentinel node showed an 8% cost saving, mainly associated with the immediate axillary dissections. US-FNAC of axillary lymph nodes in breast cancer patients reliably predicts the presence of metastases and therefore refers a significant number of patients to the appropriate surgical treatment, avoiding an SNB. As cost saving to the health care system in our study is mainly related to one-step axillary surgery, US-FNAC of axillary lymph nodes and frozen section of the sentinel node generate significant cost saving for patients who have metastatic nodes.

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
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Barranger E, Dubernard G, Fleurence J, et al. (2005) Subjective morbidity and quality of life after sentinel node biopsy and axillary lymph node dissection for breast cancer. J Surg Oncol 92:17

    Article  PubMed  Google Scholar 

  2. Fleissig A, Fallowfield LJ, Langridge CI, et al. (2005) Post-operative arm morbidity and quality of life. Results of the ALMANAC randomised trial comparing sentinel node biopsy with standard axillary treatment in the management of patients with early breast cancer. Breast Cancer Res Treat 15:1

    Google Scholar 

  3. Forza Operativa Nazionale sul Carcinoma Mammario (F.O.N.Ca.M) (2003) Coordinatore Veronesi U. I tumori della mammella. Linee guida sulla diagnosi, il trattamento e la riabilitazione. Florence, Italy: Scientific Press (www.senologia.it)

    Google Scholar 

  4. Schwartz GF, Giuliano AE, Veronesi U et al. (2002) Proceedings of the Consensus Conference on the role of sentinel lymph node biopsy in carcinoma of the breast. April 19 to 22, 2001, Philadelphia, Pennsylvania. Hum Pathol 33:579

  5. Forza Operativa Nazionale sul Carcinoma Mammario (F.O.N.Ca.M) (2005) Linee guida sulla diagnosi, il trattamento e la riabilitazione. Aggiornamento 2005. Attualità in Senologia 46:33

    Google Scholar 

  6. Lyman GH, Giuliano AE, Somerfield MR, et al. (2005) American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol 23:7703

    Article  PubMed  Google Scholar 

  7. Vaidya JS, Dewar JA, Brown DC, et al. (2005) A mathematical model for the effect of false-negative sentinel node biopsy on breast cancer mortality: a tool for everyday use. Breast Cancer Res 7:225

    Article  PubMed  Google Scholar 

  8. Okamoto T, Yamazaki K, Kanbe M, et al. (2005) Probability of axillary lymph node metastasis when sentinel node biopsy is negative in women with clinically node negative breast cancer: a Bayesian approach. Breast Cancer 12:203

    Article  PubMed  Google Scholar 

  9. Couto D, Dias M, Gonçalo M, et al. (2004) Diagnostic value of ultrasound and color Doppler in identifying axillary lymph node metastases in patients with breast cancer. Eur J Gynaecol Oncol 25:568

    PubMed  CAS  Google Scholar 

  10. Bonnema J, van Geel AN, van Ooijen B, et al. (1997) Ultrasound-guided aspiration biopsy for detection of nonpalpable axillary node metastases in breast cancer patients: new diagnostic method. World J Surg 21:270

    Article  PubMed  CAS  Google Scholar 

  11. Esen G, Gurses B, Yilmaz MH, et al. (2005) Gray scale and power Doppler US in the preoperative evaluation of axillary metastases in breast cancer patients with no palpable lymph nodes. Eur Radiol 15:1215

    Article  PubMed  Google Scholar 

  12. Sapino A, Cassoni P, Zanon E, et al. (2003) Ultrasonographically-guided fine-needle aspiration of axillary lymph nodes: role in breast cancer management. Br J Cancer 88:702

    Article  PubMed  CAS  Google Scholar 

  13. Lemos S, Dias M, Gonçalo M, et al. (2005) Detection of axillary metastases in breast cancer patients using ultrasound and colour Doppler combined the fine needle aspiration cytology. Eur J Gynaecol Oncol 26:165

    PubMed  CAS  Google Scholar 

  14. Krishnamurthy S, Sneige N, Bedi DG, et al. (2002) Role of ultrasound-guided fine-needle aspiration of indeterminate and suspicious axillary lymph nodes in the initial staging of breast carcinoma. Cancer 95:982

    Article  PubMed  Google Scholar 

  15. Kuenen-Boumeester V, Menke-Pluymers M, de Kanter AY, et al. (2003) Ultrasound-guided fine needle aspiration cytology of axillary lymph nodes in breast cancer patients: a preoperative staging procedure. Eur J Cancer 39:170

    Article  PubMed  CAS  Google Scholar 

  16. Brancato B, Zappa M, Bricolo D, et al. (2004) Role of ultrasound-guided fine needle cytology of axillary lymph nodes in breast carcinoma staging. Radiol Med 108:345

    Google Scholar 

  17. Deurloo EE, Tanis PJ, Gilhuijs KGA, et al. (2003) Reduction in the number of sentinel lymph node procedures by preoperative ultrasonography of the axilla in breast cancer. Eur J Cancer 39:1068

    Article  PubMed  CAS  Google Scholar 

  18. Van Rijk MC, Deurloo EE, Nieweg OE, et al. (2006) Ultrasonography and fine-needle aspiration cytology can spare breast cancer patients unnecessary sentinel lymph node biopsy. Ann Surg Oncol 13:31

    Article  PubMed  Google Scholar 

  19. Verbanck J, Vandewiele I, De Winter H, et al. (1997) Value of axillary ultrasonography and sonographically guided puncture of axillary nodes: a prospective study in 144 consecutive patients. J Clin Ultrasound 25:53

    Article  PubMed  CAS  Google Scholar 

  20. De Kanter AY, van Eijck CHJ, van Geel AN, et al. (1999) Multicentre study of ultrasonographically guided axillary node biopsy in patients with breast cancer. Br J Surg 86:1459

    Article  PubMed  Google Scholar 

  21. Podkrajsec M, Music MM, Kadivec M, et al. (2005) Role of ultrasound in tne preoperative staging of patients with breast cancer. Eur Radiol 15:1044

    Article  Google Scholar 

  22. Zgajnar J, Hocevar M, Podkrajsec M, et al. (2005) Patients with preoperatively ultrasonically uninvolved axillary lymph nodes: a distinct subgroup of early breast cancer patients. Breast Cancer Res Treat Dec 7:1

    Google Scholar 

  23. De Kanter AY, van Geel AN, Paul MA, et al. (2000) Controlled introduction of the sentinel node biopsy in breast cancer in a multicentre setting: the role of a coordinator for quality control. Eur J Surg Oncol 26:652

    Article  PubMed  Google Scholar 

  24. Rahusen FD, Torrenga H, van Diest PJ, et al. (2001) Predictive factors for metastatic involvement of nonsentinel nodes in patients with breast cancer. Arch Surg 136:1059

    Article  PubMed  CAS  Google Scholar 

  25. Veronesi U, Zurrida S, Mazzarol G, et al. (2001) Extensive frozen section examination of axillary sentinel nodes to determine selective axillary dissection. World J Surg 25:806

    Article  PubMed  CAS  Google Scholar 

  26. Tew K, Irwig L, Matthews A, et al. (2005) Meta-analysis of sentinel node imprint cytology in breast cancer. Br J Surg 92:1068

    Article  PubMed  CAS  Google Scholar 

  27. Schrenk P, Konstantiniuk P, Wolfl S, et al. (2005) Intraoperative frozen section examination of sentinel lymph node in breast cancer. Rozhl Chir 84:217

    PubMed  CAS  Google Scholar 

  28. Skinner KA, Silverstein MJ (2001) The management of ductal carcinoma in situ of the breast. Endocr Relat Cancer 8:33

    Article  PubMed  CAS  Google Scholar 

  29. Wilkie C, White L, Dupont E, et al. (2005) An update of sentinel lymph node mapping in patients with ductal carcinoma in situ. Am J Surg 190:563

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Ginteam, our Mini Invasive Gynaecological and Breast Surgical Unit, shares in a Task Force of Senology, a multidisciplinary group operating within the observance of diagnostic and therapeutic predefined and organized processes, working methods, and clinical protocols that are subjected to audits on correctness and effectiveness. The Unit operates in agreement with guidelines, and in cooperation with National Health Service doctors and specialists. Each team sharing in the Task Force achieved the ISO 9001 certification on professional service quality. “SNB procedure is very much a team effort with active skilled involvement of multiple disciplines” [6], so the authors wish to express their gratitude to all nonauthor components of the joint management: executive secretary and nurses (Cristiana Molino, Maria Laudisio, Patrizia Miniscalco, Isabella Nocito, Monica Scarpello, Patrizia Todisco); radiologists (Chiara Gallino, Simona Morello); doctors from Nuclear Medicine Units of Mauriziano Hospital in Turin (Osvaldo Elia) and Santa Croce Hospital in Moncalieri (Giovanni Bertuccio, Giacomo Canavese); Ginteam members (Simona Aidala, Marilena Cozzarella, Davide D’alessandro, Elena Delpiano, Raffaella Enria, Giorgio Febo, Chiara Perono Biacchiardi); plastic surgeons (Massimo Baruffaldi, Franco Maniglia, Attilio Perla, Stefania Renditore); anesthetists (Luisa Bellero, Enrica Balestra, Marina Innocenti, Maurizio Moretti, Marina Pinsoglio, Andrea Rava, Giuseppe Rossi, Antonio Vietti Ramus); pathologists (Laura Viberti, Tommaso Emmer, Giorgio Lazzari); oncologists (Gianni Fornari, Elisa Artusio, Laura Cavagna, Lorenza Mairone, Paola Sperone, Anna Turletti); and radiotherapists from San Giovanni Antica Sede in Turin (Alessandro Boidi Trotti, Paolo Rovea).

Conflicts of Interest The authors and Ginteam members indicated no potential conflicts of interest.

Author information

Author notes

  1. Franco Genta

    Present address: , Strada Rebaude 126, 10024, Moncalieri, Torino, Italy

Authors and Affiliations

  1. Ginteam, Mini-Invasive Gynaecological and Breast Surgery Unit, Evangelical Hospital, ASL 1, Torino, Italy

    Franco Genta, Marco Camanni & Francesco Deltetto

  2. Breast Radiology Unit, Evangelical Hospital, ASL 1, Torino, Italy

    Eugenio Zanon, Mauro Drogo, Rosanna Gallo & Carla Gilardi

Authors
  1. Franco Genta
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eugenio Zanon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marco Camanni
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Francesco Deltetto
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mauro Drogo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rosanna Gallo
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Carla Gilardi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Franco Genta.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Genta, F., Zanon, E., Camanni, M. et al. Cost/Accuracy Ratio Analysis in Breast Cancer Patients Undergoing Ultrasound-Guided Fine-Needle Aspiration Cytology, Sentinel Node Biopsy, and Frozen Section of Node. World J Surg 31, 1157–1165 (2007). https://doi.org/10.1007/s00268-007-9009-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-007-9009-3

Keywords

Search

Navigation