Henry-Tillman Ronda, Glover-Collins Katherine, Preston Michael, Gallagher Kristalyn, Tummel Evan, Robertson Yara V, Ochoa Daniela, Korourian Soheila, Westbrook Kent, Klimberg V Suzanne
Department of Surgery, the University of Arkansas for Medical Sciences, Little Rock, AR; Winthrop P Rockefeller Cancer Institute, the University of Arkansas for Medical Sciences, Little Rock, AR.
Department of Surgery, the University of Arkansas for Medical Sciences, Little Rock, AR; Winthrop P Rockefeller Cancer Institute, the University of Arkansas for Medical Sciences, Little Rock, AR.
J Am Coll Surg. 2015 Apr;220(4):560-7. doi: 10.1016/j.jamcollsurg.2014.12.033. Epub 2015 Jan 28.
Health care reform goals involve more cost-effective methods of delivering health care. The cost-effectiveness of axillary ultrasound-guided core needle biopsy (AUS-CNB) was compared with sentinel lymph node biopsy (SLNB) when evaluating the status of the axilla in operable invasive breast cancer.
We performed an IRB-approved retrospective review of patients undergoing ultrasound of the axilla plus core needle biopsy at our institution from 2007 to 2012. An accuracy of technique and cost analysis (TreeAge Pro 2009) of AUS-CNB vs SLNB was conducted.
The cohort of 95 patients was divided into 2 groups: clinically positive (CP) (32%) and negative (CN) (68%) axilla. In the CP group, 83% had a suspicious AUS, of which 90% were positive. In the CN group, AUS was suspicious in 70%, with a positive biopsy in 59%. The sensitivity and specificity of AUS-CNB were 90% (95% CI 84.8% to 98.8%) and 100% (95% CI 27% to 59.1%), respectively. Cost estimates comparing AUS-CNB with SLNB demonstrated a cost saving of $236,517 in the CP axilla and $248,490 in the CN axilla, for a total cost savings of $485,007.
Axillary ultrasound-guided core needle biopsy is a sensitive, diagnostic, surgeon-performed procedure. It is time-saving, cost-efficient, and less invasive, making it a viable option when evaluating the status of the axilla in invasive breast cancer or staging before neoadjuvant chemotherapy.
医疗保健改革目标涉及更具成本效益的医疗保健提供方式。在评估可手术浸润性乳腺癌腋窝状态时，将腋窝超声引导下粗针活检（AUS-CNB）与前哨淋巴结活检（SLNB）的成本效益进行了比较。
我们对2007年至2012年在本机构接受腋窝超声检查加粗针活检的患者进行了一项经机构审查委员会批准的回顾性研究。对AUS-CNB与SLNB进行了技术准确性和成本分析（TreeAge Pro 2009）。
95例患者队列分为两组：临床阳性（CP）（32%）和阴性（CN）（68%）腋窝。在CP组中，83%的患者AUS可疑，其中90%为阳性。在CN组中，70%的患者AUS可疑，活检阳性率为59%。AUS-CNB的敏感性和特异性分别为90%（95%CI 84.8%至98.8%）和100%（95%CI 27%至59.1%）。将AUS-CNB与SLNB的成本估计进行比较，结果显示CP腋窝节省成本236,517美元，CN腋窝节省成本248,490美元，总成本节省485,007美元。
腋窝超声引导下粗针活检是一种敏感、可诊断、由外科医生实施的操作。它省时、成本效益高且侵入性小，是评估浸润性乳腺癌腋窝状态或新辅助化疗前分期的可行选择。
