Pari Vijay Pandharipande MD, Presenter: Nothing to Disclose

Mukesh Gobind Harisinghani MD, Abstract Co-Author: Nothing to Disclose

Michelle C Specht MD, Abstract Co-Author: Nothing to Disclose

Chin Hur MD, Abstract Co-Author: Nothing to Disclose

Janie M. Lee MD, Abstract Co-Author: Nothing to Disclose

G. Scott Gazelle MD, PhD, Abstract Co-Author: Nothing to Disclose

MR lymphangiography (MRL) is a non-invasive, high-resolution imaging technique that enables detection of nodal malignancy. Our aim was to determine the cost-effectiveness of MRL alone, and MRL in combination with sentinel lymph node biopsy (SLNB) relative to SLNB alone for axillary staging in patients with operable, clinically node-negative Stage I or II breast cancer.

We developed a decision analytic model to simulate outcomes for a cohort of 60-year-old women with operable, clinically node-negative Stage I or II breast cancer. In two single-test strategies (MRL alone, SLNB alone), positive test results were followed by axillary dissection, while negative results ended axillary work-up. In the combined MRL-SLNB strategy, positive MRL results were followed by axillary dissection, while negative results were followed by SLNB. Parameter estimates of test performance, life expectancy reduction due to false-negative results, disease prevalence, and costs were derived from the literature. Breast conservation surgery was included in diagnostic strategy costs to avoid relative overestimation of intraoperative SLNB and axillary dissection costs shared with primary cancer removal. Markov models based on US life table and cancer registry statistics were used to derive life expectancy estimates for node-positive and node-negative patients. Sensitivity analyses were performed to evaluate the impact of key model assumptions and parameters on results.

Estimated life expectancy was nearly the same for all diagnostic strategies: MRL alone, 14.46 life years (LY); combined MRL-SLNB, 14.53 LY; SLNB alone, 14.50 LY. The single-test MRL strategy was the least expensive ($5151) and cost substantially less than SLNB alone ($6358) or combined MRL-SLNB ($6744). Life expectancy and cost-based rankings of strategies remained unchanged through a range of sensitivity analyses unless MRL sensitivity equaled that of SLNB; at this point the life expectancy of both single-test strategies was equivalent.

MRL-based strategies may have a future role in the axillary staging of operable, clinically node-negative Stage I and II breast cancer, particularly with improvement in MRL sensitivity.

Pandharipande, P, Harisinghani, M, Specht, M, Hur, C, Lee, J, Gazelle, G, Staging MR Lymphangiography of the Axilla for Operable Clinical Stage I or II Breast Cancer: A Cost-effectiveness Analysis.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4410915.html