Kosuda Shigeru, Kusano Shoichi, Kohno Naoyuki, Ohno Yoshihiro, Tanabe Tetsuya, Kitahara Satoshi, Tamai Seiichi
Departments of Radiology, Otolaryngology-Head and Neck Surgery, and Laboratory Medicine, National Defense Medical College, Tokorozawa, Japan.
Arch Otolaryngol Head Neck Surg. 2003 Oct;129(10):1105-9. doi: 10.1001/archotol.129.10.1105.
To determine the feasibility of sentinal lymph node (SN) radiolocalization and to assess the cost-effectiveness of the SN navigation surgery strategy in patients with stage N0 squamous cell carcinoma (SCC) of the head and neck. Patients Eleven consecutive patients with stage N0 SCC of the head and neck.
Head and neck lymphoscintigraphy was performed 2 hours after the injection of technetium Tc 99m tin colloid or phytate. A handheld gamma probe was used to detect the SN before and directly after making a skin incision. Nodes were evaluated histopathologically for micrometastasis. To determine the expected cost savings, a decision tree sensitivity analysis was designed based on the 2 competing strategies: ipsilateral neck dissection vs SN navigation surgery. The costs referred to billed costs based on the Japanese national insurance reimbursement system.
The sensitivity of SN navigation surgery in our series was 100% (11/11) on a patient-by-patient basis and 94% (17/18) on a node-by-node basis. Micrometastasis was found in 36% (4/11). Assuming the micrometastasis prevalence, sensitivity, and specificity of navigation surgery for detecting SN to be 30%, 90%, and 100%, respectively, the decision tree sensitivity analysis showed that introduction of SN navigation surgery in place of ipsilateral neck dissection would yield cost savings of $1218 (US) per stage N0 patient in Japan and avoid 7 surgical deaths per 1000 patients who are supposed to undergo neck dissection in the neck dissection strategy. Break-even point analysis for the SN navigation surgery strategy showed that the threshold value required more than 41 patients for the savings to begin to accrue.
Our results indicate that SN navigation surgery using radiolocalization is feasible and cost-effective, based on decision tree sensitivity analysis, in patients with stage N0 SCC of the head and neck.
确定前哨淋巴结（SN）放射性定位的可行性，并评估前哨淋巴结导航手术策略在N0期头颈部鳞状细胞癌（SCC）患者中的成本效益。患者 连续11例N0期头颈部SCC患者。
注射锝Tc 99m锡胶体或植酸盐2小时后进行头颈部淋巴闪烁显像。在皮肤切口前后使用手持γ探测器检测前哨淋巴结。对淋巴结进行组织病理学评估以检测微转移。为确定预期的成本节约，基于两种相互竞争的策略设计了决策树敏感性分析：同侧颈清扫术与前哨淋巴结导航手术。成本是指基于日本国家保险报销系统的计费成本。
在我们的系列研究中，前哨淋巴结导航手术在逐个患者基础上的敏感性为100%（11/11），在逐个淋巴结基础上的敏感性为94%（17/18）。36%（4/11）发现有微转移。假设前哨淋巴结导航手术检测前哨淋巴结的微转移患病率、敏感性和特异性分别为30%、90%和100%，决策树敏感性分析表明，在日本，用前哨淋巴结导航手术替代同侧颈清扫术，每例N0期患者可节省成本1218美元（美国），并避免颈清扫术策略中每1000例拟行颈清扫术患者中有7例手术死亡。前哨淋巴结导航手术策略的盈亏平衡点分析表明，要开始产生节约成本，所需的阈值超过41例患者。
我们的结果表明，基于决策树敏感性分析，对于N0期头颈部SCC患者，使用放射性定位的前哨淋巴结导航手术是可行且具有成本效益的。
