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Cost-Effectiveness Analysis of Routine Frozen-Section Analysis of Breast Margins Compared with Reoperation for Positive Margins

  • American Society of Breast Surgeons
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Negative margins are associated with decreased local recurrence after lumpectomy for breast cancer. A 2nd operation for re-excision of positive margins is required with rates varying from 15 to 50%. At our institution we routinely use frozen-section analysis of all margins to minimize rates of 2nd operations. The aim of this study was to evaluate the cost/benefit of routine frozen-section analysis.

Methods

A decision tree was built to compare 2 strategies: (A) lumpectomy without frozen section and a 2nd operation for positive margin(s) versus (B) lumpectomy with intraoperative frozen-section analysis and a 2nd operation for positive margin(s). For strategy A the rate of positive margins and reoperation were varied from 15 to 50%. For strategy B, a 2nd operation rate of 3% was used. Review of our institutional experience demonstrates an intraoperative re-excision of at least 1 margin in 57% of cases performed with frozen-section support.

Results

The cost to provider (i.e., institution) per patient resected to negative margins for strategy A ranged from $4835 to $6306. Average weighted cost of strategy B was $5708. Strategy B was less expensive when the reoperation rate was above 36%. The cost to payor (i.e., Medicare) for strategy A ranged from $3577 to $4665. Average weighted cost for strategy B was $3913. Strategy B was less expensive when the re-excision rate was above 26%.

Conclusion

Routine use of frozen-section analysis of lumpectomy margins decreases reoperation rates for margin control; therefore, the cost to provider and payor can be cost effective.

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Authors and Affiliations

  1. Department of Surgery, Mayo Clinic, Rochester, MN, USA

    John B. Osborn MSc, James W. Jakub MD, Amy C. Degnim MD & Judy C. Boughey MD

  2. Department of Laboratory Medicine/Pathology, Mayo Clinic, Rochester, MN, USA

    Gary L. Keeney MD

Authors
  1. John B. Osborn MSc
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  2. Gary L. Keeney MD
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  3. James W. Jakub MD
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  4. Amy C. Degnim MD
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  5. Judy C. Boughey MD
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Corresponding author

Correspondence to Judy C. Boughey MD.

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Osborn, J.B., Keeney, G.L., Jakub, J.W. et al. Cost-Effectiveness Analysis of Routine Frozen-Section Analysis of Breast Margins Compared with Reoperation for Positive Margins. Ann Surg Oncol 18, 3204–3209 (2011). https://doi.org/10.1245/s10434-011-1956-0

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  • DOI: https://doi.org/10.1245/s10434-011-1956-0

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