{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T07:21:28Z","timestamp":1761895288674},"reference-count":19,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2011,5,14]],"date-time":"2011-05-14T00:00:00Z","timestamp":1305331200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"Don and Erika Wallace Breast Cancer Research Foundation"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2011,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Learning Objectives<\/jats:title>\n                  <jats:p>After completing this course, the reader will be able to: Identify patients likely to benefit from preoperative axillary ultrasound.Define the clinical implications of a preoperative axillary ultrasound and FNA in patient care.<\/jats:p>\n                  <jats:p>CME This article is available for continuing medical education credit at CME.TheOncologist.com<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Purpose.<\/jats:title>\n                  <jats:p>Preoperative axillary sonography with fine needle aspiration (FNA) in patients with invasive breast cancer identifies patients with nodal metastasis who can be spared further surgery. Indiscriminate use of the diagnostic modality can increase costs and yield inaccurate results. We evaluate the costs associated with the use of highly sensitive axillary ultrasonography in patients with stage \u2265T2 tumors.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Patients and Methods.<\/jats:title>\n                  <jats:p>We constructed a decision analysis tree using TreeAge Pro 2009 software comparing direct hospital charges between patients with and without routine use of axillary ultrasound. Base case estimates were derived from our institutional data and compared with those derived from the literature. One- and two-way sensitivity analyses were performed to check the validity of our inferences.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results.<\/jats:title>\n                  <jats:p>We found that, for the base case estimate with 35% lymph node positivity in stage \u2265T2 tumors and sensitivity of the axillary ultrasound set at 86% with a specificity of 40%, the strategy to perform preoperative axillary ultrasound yielded rollback costs of $15,215, compared with $15,940 for surgery plus sentinel lymph node biopsy (cost difference, $725 per patient favoring axillary ultrasound). On two-way sensitivity analysis, the cost benefit for axillary ultrasound was not seen in patients with a low risk for nodal metastasis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion.<\/jats:title>\n                  <jats:p>The adoption of routine preoperative axillary sonography with FNA is a lower-cost strategy than conventional strategies in patients with stage \u2265T2 invasive breast cancer.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1634\/theoncologist.2010-0373","type":"journal-article","created":{"date-parts":[[2011,5,15]],"date-time":"2011-05-15T00:26:37Z","timestamp":1305419197000},"page":"942-948","source":"Crossref","is-referenced-by-count":13,"title":["Selective Application of Routine Preoperative Axillary Ultrasonography Reduces Costs for Invasive Breast Cancers"],"prefix":"10.1093","volume":"16","author":[{"given":"Kiran K.","family":"Turaga","sequence":"first","affiliation":[{"name":"a Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA;"},{"name":"b Comprehensive Breast Program, Department of Women's Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alec","family":"Chau","sequence":"additional","affiliation":[{"name":"c Division of Breast Imaging, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer M.","family":"Eatrides","sequence":"additional","affiliation":[{"name":"e University of South Florida College of Medicine, Tampa, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John V.","family":"Kiluk","sequence":"additional","affiliation":[{"name":"b Comprehensive Breast Program, Department of Women's Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA"},{"name":"d Departments of Oncologic Sciences and Surgery, Tampa, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nazanin","family":"Khakpour","sequence":"additional","affiliation":[{"name":"b Comprehensive Breast Program, Department of Women's Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA"},{"name":"d Departments of Oncologic Sciences and Surgery, Tampa, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine","family":"Laronga","sequence":"additional","affiliation":[{"name":"b Comprehensive Breast Program, Department of Women's Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA"},{"name":"d Departments of Oncologic Sciences and Surgery, Tampa, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M. Catherine","family":"Lee","sequence":"additional","affiliation":[{"name":"b Comprehensive Breast Program, Department of Women's Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA"},{"name":"d Departments of Oncologic Sciences and Surgery, Tampa, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2011,5,14]]},"reference":[{"key":"2021122310000703900_B1","doi-asserted-by":"crossref","first-page":"953","DOI":"10.1245\/s10434-010-0919-1","article-title":"Cost modeling of preoperative axillary ultrasound and fine-needle aspiration to guide surgery for invasive breast cancer","volume":"17","author":"Boughey","year":"2010","journal-title":"Ann Surg Oncol"},{"key":"2021122310000703900_B2","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1245\/s10434-007-9524-3","article-title":"The critical role of axillary ultrasound and aspiration biopsy in the management of breast cancer patients with clinically negative axilla","volume":"15","author":"Hinson","year":"2008","journal-title":"Ann Surg Oncol"},{"key":"2021122310000703900_B3","doi-asserted-by":"crossref","first-page":"982","DOI":"10.1002\/cncr.10786","article-title":"Role of ultrasound-guided fine-needle aspiration of indeterminate and suspicious axillary lymph nodes in the initial staging of breast carcinoma","volume":"95","author":"Krishnamurthy","year":"2002","journal-title":"Cancer"},{"key":"2021122310000703900_B4","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1038\/sj.bjc.6600744","article-title":"Ultrasonographically-guided fine-needle aspiration of axillary lymph nodes: Role in breast cancer management","volume":"88","author":"Sapino","year":"2003","journal-title":"Br J Cancer"},{"key":"2021122310000703900_B5","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1111\/j.1524-4741.2008.00600.x","article-title":"Preoperative axillary staging in breast cancer-saving time and resources","volume":"14","author":"Tahir","year":"2008","journal-title":"Breast J"},{"key":"2021122310000703900_B6","first-page":"139","article-title":"Ultrasound detection of axillary lymph node metastases in breast cancer","volume":"15","author":"Tate","year":"1989","journal-title":"Eur J Surg Oncol"},{"key":"2021122310000703900_B7","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1245\/ASO.2005.01.024","article-title":"Ultrasonography and fine-needle aspiration cytology can spare breast cancer patients unnecessary sentinel lymph node biopsy","volume":"13","author":"Rijk","year":"2006","journal-title":"Ann Surg Oncol"},{"key":"2021122310000703900_B8","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1007\/s002689900227","article-title":"Ultrasound-guided aspiration biopsy for detection of nonpalpable axillary node metastases in breast cancer patients: New diagnostic method","volume":"21","author":"Bonnema","year":"1997","journal-title":"World J Surg"},{"key":"2021122310000703900_B9","first-page":"345","article-title":"Role of ultrasound-guided fine needle cytology of axillary lymph nodes in breast carcinoma staging","volume":"108","author":"Brancato","year":"2004","journal-title":"Radiol Med"},{"key":"2021122310000703900_B10","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1007\/s10549-006-9355-0","article-title":"Accuracy of fine needle aspiration cytology (FNAC) of axillary lymph nodes as a triage test in breast cancer staging","volume":"103","author":"Ciatto","year":"2007","journal-title":"Breast Cancer Res Treat"},{"key":"2021122310000703900_B11","doi-asserted-by":"crossref","first-page":"1545","DOI":"10.1245\/s10434-006-9095-8","article-title":"Ultrasound-guided fine-needle aspiration of clinically negative lymph nodes versus sentinel node mapping in patients at high risk for axillary metastasis","volume":"13","author":"Davis","year":"2006","journal-title":"Ann Surg Oncol"},{"key":"2021122310000703900_B12","doi-asserted-by":"crossref","first-page":"1155","DOI":"10.1007\/s00268-007-9009-3","article-title":"Cost\/accuracy ratio analysis in breast cancer patients undergoing ultrasound-guided fine-needle aspiration cytology, sentinel node biopsy, and frozen section of node","volume":"31","author":"Genta","year":"2007","journal-title":"World J Surg"},{"key":"2021122310000703900_B13","doi-asserted-by":"crossref","first-page":"1063","DOI":"10.1245\/s10434-009-0351-6","article-title":"Neoadjuvant chemotherapy for breast cancer: Does pretreatment axillary nodal staging improve decision making?","volume":"16","author":"Batsis","year":"2009","journal-title":"Ann Surg Oncol"},{"key":"2021122310000703900_B14","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1245\/s10434-010-1171-4","article-title":"Consequences of axillary ultrasound in patients with T2 or greater invasive breast cancers","volume":"18","author":"Lee","year":"2011","journal-title":"Ann Surg Oncol"},{"key":"2021122310000703900_B15","doi-asserted-by":"crossref","first-page":"3670","DOI":"10.1200\/JCO.2006.08.8013","article-title":"Doctor, what are my chances of having a positive sentinel node? 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