Impact of sentinel lymph node mapping on relative charges in patients withearly-stage breast cancer

Background: The introduction of SLNB has allowed accurate staging in early- stage breast carcinomas and has minimized the number of unnecessary ALNDs. Intraoperative frozen-section analysis is a fundamental component of the se ntinel lymph node biopsy (SLNB) procedure. Some patients have positive node s on frozen-section analysis and thus undergo a conventional axillary lymph node dissection (ALND) at the time of the SLNB. A few patients have negati ve nodes on frozen-section analysis but have subsequent evidence of metasta ses on final pathologic examination. The purpose of our study was 2-fold: t o compare the hospital-related charges of patients undergoing staging by SL NB with those of patients undergoing conventional ALND and to assess whethe r the different outcomes associated with SLNB adversely affect the charges incurred with this procedure. Methods: Our study group consisted of 100 patients with T1 breast cancer an d breast conservation therapy who underwent either SLNB or ALND from July 1 , 1997, to June 30, 1998. We identified the first 50 consecutive patients t o undergo SLNB during this period. We chose a similar cohort of 50 patients for ALND. Mean hospital-related charges for the SLNB patients were categor ized and compared with those for the ALND patients. Results: Results for the two groups were analyzed using a two-sample Wilcox on rank-sum test. Charges for the OR and hospital stay were less for the SL NB group (P < .05). Frozen-section analysis in the SLNB group contributed t o the significant difference in charges for pathologic evaluation. Overall, the two groups showed no significant difference in total hospital-related charges. Conclusions: When SLNB is used for T1 tumors, a small percentage of patient s (10% in our study) will return to the operating room for an ALND. This sm all percentage does not increase the charges related to SLNB, however, as t he reduced stay for most patients offsets this subgroup's contribution to t he total hospital-related charges. Thus, in patients with clinical stage I breast cancer, SLNB does not cause significantly higher hospital-related ch arges compared with conventional ALND.