caa a22 4500 445339098 CHVBK 20180317142806.0 cr unu---uuuuu 170323e20111001xx s 000 0 eng 10.1245/s10434-011-1956-0 doi (NATIONALLICENCE)springer-10.1245/s10434-011-1956-0 Cost-Effectiveness Analysis of Routine Frozen-Section Analysis of Breast Margins Compared with Reoperation for Positive Margins [Elektronische Daten] [John Osborn, Gary Keeney, James Jakub, Amy Degnim, Judy Boughey] 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. Society of Surgical Oncology, 2011 Osborn John Department of Surgery, Mayo Clinic, Rochester, MN, USA aut Keeney Gary Department of Laboratory Medicine/Pathology, Mayo Clinic, Rochester, MN, USA aut Jakub James Department of Surgery, Mayo Clinic, Rochester, MN, USA aut Degnim Amy Department of Surgery, Mayo Clinic, Rochester, MN, USA aut Boughey Judy Department of Surgery, Mayo Clinic, Rochester, MN, USA aut Annals of Surgical Oncology Springer-Verlag 18/11(2011-10-01), 3204-3209 1068-9265 18:11<3204 2011 18 10434 https://doi.org/10.1245/s10434-011-1956-0 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1245/s10434-011-1956-0 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Osborn John Department of Surgery, Mayo Clinic, Rochester, MN, USA aut NATIONALLICENCE 700 1- Keeney Gary Department of Laboratory Medicine/Pathology, Mayo Clinic, Rochester, MN, USA aut NATIONALLICENCE 700 1- Jakub James Department of Surgery, Mayo Clinic, Rochester, MN, USA aut NATIONALLICENCE 700 1- Degnim Amy Department of Surgery, Mayo Clinic, Rochester, MN, USA aut NATIONALLICENCE 700 1- Boughey Judy Department of Surgery, Mayo Clinic, Rochester, MN, USA aut NATIONALLICENCE 773 0- Annals of Surgical Oncology Springer-Verlag 18/11(2011-10-01), 3204-3209 1068-9265 18:11<3204 2011 18 10434 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer