Shin Eugene T, Joehlin-Price Amy S, Agnese Doreen M, Zynger Debra L
Departments of Pathology.
Surgical Oncology, The Ohio State University Medical Center, Columbus.
Am J Clin Pathol. 2017 Nov 2;148(5):374-379. doi: 10.1093/ajcp/aqx089.
There is little information regarding sentinel lymph node (SLN) frozen-section examination in patients with a history of ductal carcinoma in situ (DCIS). We evaluated the usage, clinical impact, and pathology resources used for SLN cryosectioning in mastectomy cases with a DCIS history.
Mastectomies with SLNs submitted from 2012 to 2013 at a tertiary care center were analyzed. Medicare reimbursement was used to estimate pathology health care expenditures of intraoperative frozen sections.
There was no difference in the rate of SLN frozen-section examination or parts submitted, total blocks frozen, total blocks submitted, or total SLNs identified per case between the DCIS (n = 139) and invasive (n = 369) groups. Nine patients with DCIS had SLN metastases (three macrometastases, two micrometastases, and four isolated tumor cells), all of which were examined by frozen section. Only the macrometastases were identified by cryosectioning, which led to two synchronous axillary lymph node dissections that did not yield any additional positive nodes. A total of $19,313 was spent for pathology per DCIS patient with surgical management affected, whereas only $1,019 was spent per invasive carcinoma patient affected.
Decreasing SLN frozen-section use in patients with a history of DCIS represents an opportunity for pathology cost containment.
关于原位导管癌（DCIS）病史患者前哨淋巴结（SLN）冰冻切片检查的信息较少。我们评估了有DCIS病史的乳房切除术病例中SLN冷冻切片检查的使用情况、临床影响以及所使用的病理资源。
分析了2012年至2013年在一家三级医疗中心提交的带有SLN的乳房切除术病例。使用医疗保险报销来估计术中冰冻切片的病理医疗费用。
DCIS组（n = 139）和浸润性癌组（n = 369）之间，SLN冰冻切片检查率、送检部位、冰冻总块数、送检总块数或每例识别出的SLN总数均无差异。9例DCIS患者发生SLN转移（3例大转移、2例微转移和4例孤立肿瘤细胞），所有这些均通过冰冻切片检查。冰冻切片仅识别出大转移，这导致了2次同步腋窝淋巴结清扫，未发现其他阳性淋巴结。每位接受手术治疗的DCIS患者的病理费用总计为19,313美元，而每位浸润性癌患者的费用仅为1,019美元。
减少有DCIS病史患者的SLN冰冻切片检查使用是控制病理成本的一个机会。
