外阴癌患者前哨淋巴结活检与腹股沟-股部淋巴结清扫术的成本效益比较。

BACKGROUND

This study examines the cost-effectiveness of sentinel lymph node biopsy, a potentially less morbid procedure, compared with inguinofemoral lymphadenectomy (IFL) among women with stage I and stage II vulval squamous cell carcinoma.

METHODS

A model-based economic evaluation was undertaken based on clinical evidence from a systematic review of published sources. A decision tree model was developed with the structure being informed by clinical input, taking the perspective of the health-care provider.

RESULTS

For overall survival for 2 years, IFL was found to be the most cost-effective option and dominated all other strategies, being the least costly and most effective. For morbidity-free related outcomes for 2 years, sentinel lymph node (SLN) biopsy with 99mTc and blue dye and haematoxylin & eosin (H&E) histopathology, with ultrastaging and immunohistochemistry reserved for those that test negative following H&E is likely to be the most effective approach.

CONCLUSION

SLN biopsy using 99mTc and blue dye with ultrastaging may be considered the most cost-effective strategy based on the outcome of survival free of morbidity for 2 years. The findings here also indicate that using blue dye and H&E for the identification of the SLN and the identification of metastasis, respectively, are not sensitive enough to be used on their own.

背景

本研究考察了前哨淋巴结活检的成本效益，与 IFL 相比，前哨淋巴结活检在 I 期和 II 期外阴鳞癌患者中具有潜在的较低的发病率。

方法

基于系统评价中发表文献的临床证据，进行了基于模型的经济评估。开发了一个决策树模型，其结构由临床输入提供信息，并从医疗保健提供者的角度出发。

结果

对于 2 年的总生存率，IFL 被认为是最具成本效益的选择，并且优于所有其他策略，因为它的成本最低，效果最佳。对于 2 年无病相关结果，99mTc 和蓝染料联合苏木精和伊红（H&E）组织病理学的前哨淋巴结（SLN）活检，对于 H&E 检测阴性的患者保留超微结构检查和免疫组织化学检查，可能是最有效的方法。