School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, UK.
Eur J Surg Oncol. 2011 Jan;37(1):40-6. doi: 10.1016/j.ejso.2010.10.001. Epub 2010 Nov 27.
UK guidelines for breast cancer recommend axillary nodal assessment via surgical methods such as sentinel lymph node biopsy (SLNB). However, these procedures are associated with adverse effects such as lymphoedema. Magnetic resonance imaging (MRI) and positron emission tomography (PET) are non-invasive imaging techniques. The aim of this study is to evaluate the cost-effectiveness of MRI and PET compared with SLNB for assessment of axillary lymph node metastases in newly-diagnosed early stage breast cancer patients in the UK.
An individual patient discrete-event simulation model was developed in SIMUL8(®) to estimate the lifetime costs and benefits of replacing SLNB with MRI or PET, or adding MRI or PET before SLNB. Effectiveness outcomes were derived from a recent systematic review; patient utilities and resource use data were sourced from the literature.
Based on our analysis the baseline SLNB strategy is dominated by the strategies of replacing SLNB with either MRI or PET. The strategy of replacing SLNB with MRI has the highest total quality-adjusted life years (QALYs) and lowest total costs. However, clinical evidence for MRI is based on a limited number of small studies and replacing SLNB with MRI or PET leads to more false-positive and false-negative cases. The strategy of adding MRI before SLNB is cost-effective, but subject to greater uncertainty.
Based on this analysis the most cost-effective strategy is to replace SLNB with MRI. However, further large studies using up-to-date techniques are required to obtain more accurate data on the sensitivity and specificity of MRI.
英国乳腺癌指南建议通过手术方法（如前哨淋巴结活检术 [SLNB]）对腋窝淋巴结进行评估。然而，这些手术程序会引起淋巴水肿等不良影响。磁共振成像（MRI）和正电子发射断层扫描（PET）是两种非侵入性成像技术。本研究旨在评估 MRI 和 PET 用于评估新诊断的早期乳腺癌患者腋窝淋巴结转移的成本效益，与 SLNB 相比。
在 SIMUL8（®）中开发了个体患者离散事件模拟模型，以估算用 MRI 或 PET 替代 SLNB，或在 SLNB 之前添加 MRI 或 PET 的终生成本和效益。疗效结果来自最近的系统评价；患者效用和资源使用数据来自文献。
根据我们的分析，SLNB 策略是主导的策略是用 MRI 或 PET 替代 SLNB。用 MRI 替代 SLNB 的策略具有最高的总质量调整生命年（QALYs）和最低的总成本。然而，MRI 的临床证据基于有限的小型研究，并且用 MRI 或 PET 替代 SLNB 会导致更多的假阳性和假阴性病例。在 SLNB 之前添加 MRI 的策略具有成本效益，但存在更大的不确定性。
根据这项分析，最具成本效益的策略是用 MRI 替代 SLNB。然而，需要使用最新技术进行更多的大型研究，以获得关于 MRI 的敏感性和特异性的更准确数据。
