Alperovich Michael, Reis Scott M, Choi Mihye, Karp Nolan S, Frey Jordan D, Chang Jessica B, Axelrod Deborah M, Shapiro Richard L, Guth Amber A
New York University Medical Center, New York, NY, USA.
Ann Surg Oncol. 2016 Feb;23(2):490-3. doi: 10.1245/s10434-015-4882-8. Epub 2015 Oct 5.
Permanent paraffin subareolar biopsy during nipple-sparing mastectomy (NSM) tests for occult cancer at the nipple-areolar complex. Intraoperative subareolar frozen section can provide earlier detection intraoperatively. Cost analysis for intraoperative subareolar frozen section has never been performed.
NSM cases from 2006-2013 were reviewed. Patient records including financial charges were analyzed.
Of 480 subareolar biopsies for NSM from 2006-2013, 21 were abnormal (4.4 %). A total of 307 of the subareolar biopsies included intraoperative frozen section. Of the 307, 12 (3.9 %) were abnormal with 7 of 12 detected on intraoperative frozen section. The median baseline charge for an intraoperative subareolar frozen section was $309 for an estimated total cost of $94,863 in 307 breasts. The median baseline charge for interval operative resection of a nipple-areolar complex following an abnormal subareolar pathology result was $11,021. Intraoperative subareolar biopsy avoided an estimated six return trips to the operating room for savings of $66,126. At our institution, routine use of intraoperative frozen section resulted in an additional $28,737 in healthcare charges or $95 per breast.
We present the first cost analysis to evaluate intraoperative subareolar frozen section in NSM. This practice obviated an estimated six return trips to the operating room. With our institutional frequency of abnormal subareolar pathology, intraoperative frozen sections resulted in a marginal increased charge per mastectomy.
保乳手术（NSM）期间进行的乳晕下永久石蜡活检用于检测乳晕复合体处的隐匿性癌症。术中乳晕下冰冻切片可在术中更早地发现病变。目前尚未对术中乳晕下冰冻切片进行成本分析。
回顾2006年至2013年期间的保乳手术病例。分析包括费用在内的患者记录。
在2006年至2013年期间进行的480例乳晕下活检中，21例异常（4.4%）。总共307例乳晕下活检包括术中冰冻切片。在这307例中，12例（3.9%）异常，其中12例中的7例在术中冰冻切片时被检测到。术中乳晕下冰冻切片的基线费用中位数为309美元，307例乳房的估计总成本为94,863美元。乳晕下病理结果异常后，乳晕复合体间隔手术切除的基线费用中位数为11,021美元。术中乳晕下活检避免了估计六次返回手术室，节省了66,126美元。在我们机构，常规使用术中冰冻切片导致医疗费用额外增加28,737美元，即每例乳房增加95美元。
我们首次进行成本分析以评估保乳手术中术中乳晕下冰冻切片的情况。这种做法避免了估计六次返回手术室。根据我们机构乳晕下病理异常的发生率，术中冰冻切片导致每例乳房切除术的费用略有增加。
