Determining whether cancer has spread to the lymph nodes is important in predicting survival from breast cancer and determining what treatment a patient requires. The traditional method of detecting such metastases, complete axillary node dissection, can result in lymphedema and other quality-of-life damaging side effects. The new technique of sentinel lymph node biopsy (SLNB) offers a way to test for lymph node metastases without causing the side effects of traditional axillary node dissection. Intraoperative analysis of SLNB is becoming an effective tool in assessment of the presence or absence of metastatic tumor, and therefore influences the treatment offered to the patient. Because of this central diagnostic use, as it is a new procedure, further studies need to be conducted to fully assess its role in breast cancer treatment.

Objectives: The feasibility and accuracy of sentinel lymph node biopsy (SLNB) in the treatment of breast cancer is widely acknowledged today. The aim of our study was to compare the hospital-related costs of this strategy with those of conventional axillary lymph node dissection (ALND).

Methods: A retrospective study was carried out to determine the total direct medical costs for each of the two medical strategies. Two patient samples (n=43 for ALND; n=48 for SLNB) were selected at random among breast cancer patients at the Centre Léon Bérard, a comprehensive cancer treatment center in Lyon, France. Costs related to ALND carried out after SLNB (either immediately or at a later date) were included in SLNB costs (n=18 of 48 patients).

Results: Total direct medical costs were significantly different in the two groups (median 1,965.86€ versus 1,429.93€, p=0.0076, Mann-Whitney U-test). The total cost for SLNB decreased even further for patients who underwent SLNB alone (median, 1,301€). Despite the high cost of anatomic pathology examinations and nuclear medicine (both favorable to ALND), the difference in direct medical costs for the two strategies was primarily due to the length of hospitalization, which differs significantly depending on the technique used (9-day median for ALND versus 3 days for SLNB, p<0.0001).

Conclusions: A lower morbidity rate is favorable to the generalization of SLNB, when the patient's clinical state allows for it. From an economic point of view, SLNB also seems to be preferred, particularly because our results confirm those found in two published studies concerning the cost of SLNB.

Objectives: To assess whether sentinel lymph node biopsy (SLNB), an alternative to axillary lymph node dissection in treating female breast cancer, affords any cost savings.

Methods: We profile cumulative treatment costs of 811 breast cancer patients, 555 of whom received SLNB. Univariate and multivariate statistical tests are used to appraise whether these cost profiles differ between SLNB and other patients.

Results: The statistical results are mixed. However, none supports the conjecture that SLNB necessarily lowers the cost of treating the average breast patient.

Conclusions: SLNB may be cost-effective, but longer term costs and outcomes must be estimated before firm conclusions can be reached.