Gemignani M L, Cody H S, Fey J V, Tran K N, Venkatraman E, Borgen P I
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York 10021, USA.
Ann Surg Oncol. 2000 Sep;7(8):575-80. doi: 10.1007/BF02725336.
The introduction of SLNB has allowed accurate staging in early-stage breast carcinomas and has minimized the number of unnecessary ALNDs. Intraoperative frozen-section analysis is a fundamental component of the sentinel lymph node biopsy (SLNB) procedure. Some patients have positive nodes on frozen-section analysis and thus undergo a conventional axillary lymph node dissection (ALND) at the time of the SLNB. A few patients have negative nodes on frozen-section analysis but have subsequent evidence of metastases on final pathologic examination. The purpose of our study was 2-fold: to compare the hospital-related charges of patients undergoing staging by SLNB with those of patients undergoing conventional ALND and to assess whether the different outcomes associated with SLNB adversely affect the charges incurred with this procedure.
Our study group consisted of 100 patients with T1 breast cancer and breast conservation therapy who underwent either SLNB or ALND from July 1, 1997, to June 30, 1998. We identified the first 50 consecutive patients to undergo SLNB during this period. We chose a similar cohort of 50 patients for ALND. Mean hospital-related charges for the SLNB patients were categorized and compared with those for the ALND patients.
Results for the two groups were analyzed using a two-sample Wilcoxon rank-sum test. Charges for the OR and hospital stay were less for the SLNB group (P < .05). Frozen-section analysis in the SLNB group contributed to the significant difference in charges for pathologic evaluation. Overall, the two groups showed no significant difference in total hospital-related charges.
When SLNB is used for T1 tumors, a small percentage of patients (10% in our study) will return to the operating room for an ALND. This small percentage does not increase the charges related to SLNB, however, as the reduced stay for most patients offsets this subgroup's contribution to the total hospital-related charges. Thus, in patients with clinical stage I breast cancer, SLNB does not cause significantly higher hospital-related charges compared with conventional ALND.
前哨淋巴结活检（SLNB）的引入使得早期乳腺癌能够进行准确分期，并最大限度地减少了不必要的腋窝淋巴结清扫术（ALND）的数量。术中冰冻切片分析是前哨淋巴结活检（SLNB）手术的一个基本组成部分。一些患者在冰冻切片分析时发现淋巴结阳性，因此在进行SLNB时接受了传统的腋窝淋巴结清扫术（ALND）。少数患者在冰冻切片分析时淋巴结为阴性，但在最终病理检查时有转移的证据。我们研究的目的有两个：比较接受SLNB分期的患者与接受传统ALND的患者的医院相关费用，并评估与SLNB相关的不同结果是否会对该手术的费用产生不利影响。
我们的研究组由1997年7月1日至1998年6月30日期间接受SLNB或ALND的100例T1期乳腺癌且接受保乳治疗的患者组成。我们确定了在此期间连续接受SLNB的前50例患者。我们选择了50例类似的患者进行ALND。对SLNB患者的平均医院相关费用进行分类，并与ALND患者的费用进行比较。
使用两样本Wilcoxon秩和检验分析两组结果。SLNB组的手术室费用和住院费用较低（P <.05）。SLNB组的冰冻切片分析导致病理评估费用存在显著差异。总体而言，两组的总医院相关费用没有显著差异。
当SLNB用于T1期肿瘤时，一小部分患者（我们研究中的10%）将返回手术室进行ALND。然而，这一小部分患者并没有增加与SLNB相关的费用，因为大多数患者住院时间的减少抵消了该亚组对总医院相关费用的贡献。因此，对于临床I期乳腺癌患者，与传统ALND相比，SLNB不会导致显著更高的医院相关费用。
