Preoperative Sentinel Node Mapping in Sentinel Node Biopsy in Early Breast Cancers – Is It Cost-Effective?
Sentinel lymph node (SLN) biopsy is currently the gold standard of treatment in early breast cancers. Identification of SLNs by preoperative scintigraphy has been carried out to improve the detection of SLNs intraoperatively, but the evidence of its cost-effectiveness is lacking. Here, we analyze the cost-effectiveness of the utilization of scintigraphy in detection of SLNs.Patients and Methods
Clinical and operative details were retrieved from a prospectively maintained database. The resources and cost data from each patient who had undergone SLN biopsy with preoperative scintigraphy were retrieved.Results
From January 2008 to December 2012, 400 patients underwent SLN biopsy for breast cancer. A total of 329 had preoperative SLN mapping with scintigraphy, Baseline patient demographic data for both arms were comparable. The relapse and recurrence rate of both arms were not statistically different. The detection rate of SLNs of both arms was the same (100%), and there were no grade 2 or above lymphedema in both groups of patients. However, the cost of each patient undergoing SLN mapping was USD $345.8.Conclusion
Preoperative SLN mapping does not improve the SLN detection rate. In addition, it does not affect the surgical outcomes in terms of complication, local relapse, and recurrence. The use of preoperative SLN mapping is no longer cost-effective.Micro-Abstract
Many centers internationally still routinely perform preoperative sentinel lymph node (SLN) mapping. A recent review in 2015 also concluded that SLN mapping is playing an important role in SLN biopsy. However, in some financially less-privileged regions or localities where healthcare system is largely subsidized by the government, the extra cost incurred from the use of SLN mapping has significant implications on public health economics. This study aims to evaluate the efficacy as well as the cost-effectiveness of preoperative SLN mapping for early breast cancers.