Hospital costs and cosmetic outcome of benign and high-risk breast lesions managed by vacuum-assisted excision versus surgical excision

British Journal of Radiology - Tập 95 Số 1136 - 2022
Elles M.F. van de Voort1,2, Gerson M. Struik1,2, Sophia P van Streun1, Cornelis Verhoef2, Carin A. Uyl‐de Groot3,4, T.M.A.L. Klem1
1Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
2Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
3Department of Health Technology Assessment, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
4Institute for Medical Technoloy Assessment, Erasmus University Rotterdam , Rotterdam , the Netherlands

Tóm tắt

Objectives: Although vacuum-assisted excision (VAE) is a safe and effective alternative to surgical excision (SE), the latter is most commonly used for the management of benign and high-risk breast lesions. To evaluate the healthcare benefit of VAE, hospital costs and cosmetic outcome after VAE were compared to SE. Additionally, the impact of VAE implementation on hospital costs was investigated. Methods: This was a single-centre retrospective cohort study with two cohorts: “VAE” and “SE”. All patients with a benign or high-risk lesion excised by VAE or SE from January 2016 up to December 2019 were included. Cosmetic outcome was measured with the BCTOS-cosmetic subscale, and hospital costs were presented as mean (SD) and median (IQR). Results: During the study period, 258 patients with 295 excised lesions were included. The initial procedure was VAE in 102 patients and SE in 156 patients. Hospital costs after (median € 2324) were significantly lower than before (median € 3,144) implementation of VAE (mean difference € 1,004, p < 0.001), most likely attributable to the lower costs for patients treated with VAE (mean difference € 1,979, p < 0.001). Mean cosmetic outcome was comparable between VAE (median 1.35) and SE (median 1.44, p = 0.802). Conclusions: Implementing VAE as an alternative treatment option for benign and high-risk breast lesions resulted in a large decrease in hospital costs but a cosmetic benefit of VAE could not be demonstrated in this retrospective study. Advances in knowledge: Costs associated with the complete patient pathway were included and not only VAE was compared to SE but also the before cohort was compared to the after cohort to demonstrate the benefit of VAE implementation in clinical practice. Additionally, cosmetic outcome was compared between VAE and SE using patient reported outcome measures.

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Tài liệu tham khảo

Integraal Kankercentrum Nederland kn . Overlevingscijfers borstkanker, Stadiumverdeling bij diagnose in 2015 van borstkanker . 2015 . Available from : https://www.kanker.nl/kankersoorten/borstkanker/wat-is/overlevingscijfers-borstkanker

M.J.J.C. Poos  ACV  Gommer  AM . Borstkanker, Sterfte en Overleving: Volksgezondheid en Zorg . 2018 . Available from : https://www.volksgezondheidenzorg.info/onderwerp/borstkanker/cijfers-context/sterfte-en-overleving#node-sterfte-borstkanker

Nederland IK . Cijfers over Kanker . 2017 . Available from : https://www.cijfersoverkanker.nl/selecties/dataset_1/img5c29e0f938f6d

(RIVM) RvVeM . monitor bevolkingsonderzoek borstkanker 2016 . 2018 . Available from : https://www.rivm.nl/monitoring-en-evaluatie-bevolkingsonderzoek-borstkanker

Lakoma, 2014, Minimally invasive surgical management of benign breast lesions, Gland Surg, 3, 142

Luiten, 2019, Trends in frequency and outcome of high-risk breast lesions at core needle biopsy in women recalled at biennial screening mammography, a multiinstitutional study, Int J Cancer, 145, 2720, 10.1002/ijc.32353

Gur, 2005, Trends in recall, biopsy, and positive biopsy rates for screening mammography in an academic practice, Radiology, 235, 396, 10.1148/radiol.2352040422

Park, 2014, Vacuum-assisted breast biopsy for breast cancer, Gland Surg, 3, 120

Luo, 2011, Therapeutic application of ultrasound-guided 8-gauge mammotome system in presumed benign breast lesions, Breast J, 17, 490, 10.1111/j.1524-4741.2011.01125.x

O’Flynn, 2010, Image-guided breast biopsy: state-of-the-art, Clin Radiol, 65, 259, 10.1016/j.crad.2010.01.008

Strachan, 2016, Outcome of a new patient pathway for managing B3 breast lesions by vacuum-assisted biopsy: time to change current UK practice?, J Clin Pathol, 69, 248, 10.1136/jclinpath-2015-203018

Park, 2018, Clinicopathological analysis of ultrasound-guided vacuum-assisted breast biopsy for the diagnosis and treatment of breast disease, Anticancer Res, 38, 2455

van de Voort, 2020, Patient reported cosmetic outcome after vacuum assisted excision of benign breast lesions: a cross-sectional study, Br J Radiol, 93, 1114, 10.1259/bjr.20190994

Saarela, 1998, Cosmetic results after wire-guided biopsy of benign breast lesions, J Am Coll Surg, 187, 610, 10.1016/S1072-7515(98)00252-X

Struik, 2018, Development and psychometric evaluation of a dutch-translated shorter breast cancer treatment outcome scale (dutch BCTOS-13), J Patient Rep Outcomes, 2, 60, 10.1186/s41687-018-0085-y

Wang, 2009, Ultrasonographically guided vacuum-assisted excision for multiple breast masses: non-randomized comparison with conventional open excision, J Surg Oncol, 100, 675, 10.1002/jso.21394

Johnson, 2002, Percutaneous excisional breast biopsy, Am J Surg, 184, 550, 10.1016/S0002-9610(02)01099-1

Yao, 2012, Sonographically guided vacuum-assisted breast biopsy for complete excision of presumed benign breast lesions, J Ultrasound Med, 31, 1951, 10.7863/jum.2012.31.12.1951

Thurley, 2009, Patient satisfaction and efficacy of vacuum-assisted excision biopsy of fibroadenomas, Clin Radiol, 64, 381, 10.1016/j.crad.2008.09.013

March, 2003, Breast masses: removal of all US evidence during biopsy by using a handheld vacuum-assisted device--initial experience, Radiology, 227, 549, 10.1148/radiol.2272020476

Fine, 2002, Percutaneous removal of benign breast masses using a vacuum-assisted hand-held device with ultrasound guidance, Am J Surg, 184, 332, 10.1016/S0002-9610(02)00951-0

Whitworth, 2020, Reduced hospital costs for ultrasound-guided vacuum-assisted excision compared with open surgery in patients with benign breast masses and high-risk lesions, Journal of Breast Imaging, 2, 452, 10.1093/jbi/wbaa055

Telli, 2007, Phyllodes tumors of the breast: natural history, diagnosis, and treatment, J Natl Compr Canc Netw, 5, 324, 10.6004/jnccn.2007.0027

S  CH  Boersma  LJ  Hairwassers  D  Obdeijn  AIM  van der Sangen  SM  Smit  GM  et al . Richtlijn: Borstkanker (2.0 . 2020 . Available from : https://richtlijnendatabase.nl/richtlijn/borstkanker/algemeen.html

Surgeons ASoB . Consensus Guideline on Concordance Assessment of Image-Guided Breast Biopsies and Management of Borderline or High-Risk Lesions . Available from . Available from : https://www.breastsurgeons.org/docs/statements/Consensus-Guideline-on-Concordance-Assessment-of-Image-Guided-Breast-Biopsies.pdf

Rageth, 2016, First international consensus conference on lesions of uncertain malignant potential in the breast (B3 lesions), Breast Cancer Res Treat, 159, 203, 10.1007/s10549-016-3935-4

Rageth, 2019, Second international consensus conference on lesions of uncertain malignant potential in the breast (B3 lesions), Breast Cancer Res Treat, 174, 279, 10.1007/s10549-018-05071-1

Pinder, 2018, NHS breast screening multidisciplinary working group guidelines for the diagnosis and management of breast lesions of uncertain malignant potential on core biopsy (B3 lesions), Clin Radiol, 73, 682, 10.1016/j.crad.2018.04.004

Hennigs, 2018, Development and psychometric validation of a shorter version of the breast cancer treatment outcome scale (BCTOS-12), Breast, 38, 58, 10.1016/j.breast.2017.12.002

Saladin, 2016, Lesions with unclear malignant potential (B3) after minimally invasive breast biopsy: evaluation of vacuum biopsies performed in switzerland and recommended further management, Acta Radiol, 57, 815, 10.1177/0284185115610931

Bianchi, 2011, Positive predictive value for malignancy on surgical excision of breast lesions of uncertain malignant potential (B3) diagnosed by stereotactic vacuum-assisted needle core biopsy (VANCB): a large multi-institutional study in italy, Breast, 20, 264, 10.1016/j.breast.2010.12.003

Heller, 2014, Outcome of high-risk lesions at MRI-guided 9-gauge vacuum- assisted breast biopsy, AJR Am J Roentgenol, 202, 237, 10.2214/AJR.13.10600

Lourenco, 2014, High-risk lesions at MRI-guided breast biopsy: frequency and rate of underestimation, AJR Am J Roentgenol, 203, 682, 10.2214/AJR.13.11905

Baez, 2003, Minimal invasive complete excision of benign breast tumors using a three-dimensional ultrasound-guided mammotome vacuum device, Ultrasound Obstet Gynecol, 21, 267, 10.1002/uog.74

Kim, 2010, Long-term follow-up results for ultrasound-guided vacuum-assisted removal of benign palpable breast mass, Am J Surg, 199, 1, 10.1016/j.amjsurg.2008.11.037

Povoski, 2007, A comprehensive evaluation of the 8-gauge vacuum-assisted mammotome(r) system for ultrasound-guided diagnostic biopsy and selective excision of breast lesions, World J Surg Oncol, 5, 10.1186/1477-7819-5-83

Fine, 2003, Low-risk palpable breast masses removed using a vacuum-assisted hand-held device, Am J Surg, 186, 362, 10.1016/S0002-9610(03)00263-0

Neal, 2014, Diagnosis and management of benign, atypical, and indeterminate breast lesions detected on core needle biopsy, Mayo Clin Proc, 89, 536, 10.1016/j.mayocp.2014.02.004

Calhoun, 2018, Core needle biopsy of the breast: an evaluation of contemporary data, Surg Pathol Clin, 11, 1, 10.1016/j.path.2017.09.001

Falomo, 2019, Variability in the management recommendations given for high-risk breast lesions detected on image-guided core needle biopsy at U.S. academic institutions, Curr Probl Diagn Radiol, 48, 462, 10.1067/j.cpradiol.2018.06.004

Grady, 2005, Ultrasound-guided, vacuum-assisted, percutaneous excision of breast lesions: an accurate technique in the diagnosis of atypical ductal hyperplasia, J Am Coll Surg, 201, 14, 10.1016/j.jamcollsurg.2005.02.025

Yaziji, 2021, Cost analysis of managing B3 breast lesions by vacuum excision at leeds breast unit using a decision model, BMJ Open, 11, 10.1136/bmjopen-2021-054525

Parker, 2001, Why should diagnostic benign breast biopsies weight less than twenty grams?, Ann R Coll Surg Engl, 83, 113

Wang, 2012, Percutaneous excisional biopsy of clinically benign breast lesions with vacuum-assisted system: comparison of three devices, Eur J Radiol, 81, 725, 10.1016/j.ejrad.2011.01.059

Zheng, 2020, Prediction of postoperative hematoma occurrence after ultrasound-guided vacuum-assisted breast biopsy in minimally invasive surgery for percutaneous removal of benign breast lesions, Gland Surg, 9, 1346, 10.21037/gs-20-344

Fu, 2015, Effectiveness of hemostasis with foley catheter after vacuum-assisted breast biopsy, J Thorac Dis, 7, 1213

Cardoso, 2007, Towards an intelligent medical system for the aesthetic evaluation of breast cancer conservative treatment, Artif Intell Med, 40, 115, 10.1016/j.artmed.2007.02.007

Cardoso, 2009, Comparing two objective methods for the aesthetic evaluation of breast cancer conservative treatment, Breast Cancer Res Treat, 116, 149, 10.1007/s10549-008-0173-4

Lagendijk, 2018, Evaluation of cosmetic outcome following breast-conserving therapy in trials: panel versus digitalized analysis and the role of proms, Breast J, 24, 519, 10.1111/tbj.12980

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British Journal of Radiology

Tập 95 Số 1136

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