Cutting Healthcare Costs with Hematoma-Directed Ultrasound-Guided Breast Lumpectomy

Amelia Y. Merrill, Daniela Ochoa, Vicki Klimberg, Erica L. Hill, Michael Preston, Kristen Neisler, Ronda S. Henry-Tillman

Research output: Contribution to journalReview article

Abstract

Background: Localization of nonpalpable breast lesions for breast-conserving surgery (BCS) remains highly variable and includes needle/wire localization (NL), radioactive seed localization, radar localization, and hematoma-directed ultrasound-guided (HUG) lumpectomy. The superiority of HUG lumpectomy over NL has been demonstrated repeatedly in terms of safety, accuracy, low positive margin rates, cosmesis, and patient satisfaction. In this study, we evaluate the cost effectiveness of HUG lumpectomy over NL for nonpalpable breast lesions. Methods: We performed a retrospective review of 569 patients who underwent lumpectomy at the University of Arkansas for Medical Sciences from May 2014 through December 2017. Lumpectomies were stratified by localization technique, i.e. NL versus HUG. A cost-savings estimate was determined for the HUG localization technique, and a total amount of dollars saved over the study period was calculated. Results: Overall, 569 lumpectomies were performed: 501 (88.0%) via HUG and 68 (12.0%) via NL. Intraoperative ultrasound was used in 566 operations (99.5%). Of the lumpectomies performed by HUG, 190 lesions (33.4%) were visible only on mammogram or breast magnetic resonance imaging prior to diagnostic core needle biopsy (CNB). Cost estimates comparing HUG with NL demonstrated a cost savings of $497.00 per procedure, the cost of preoperative needle localization by a radiologist, and a total of $94,430.00 for the study period. Conclusion: In utilizing HUG lumpectomy, the initial CNB serves as the diagnostic and localization procedure, thus saving time and a painful second procedure on the day of operation. HUG lumpectomy is safe, accurate, reduces healthcare costs, and results in a better patient experience for the surgical removal of nonpalpable breast lesions.

Original languageEnglish (US)
Pages (from-to)3076-3081
Number of pages6
JournalAnnals of Surgical Oncology
Volume25
Issue number10
DOIs
StatePublished - Oct 1 2018

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Segmental Mastectomy
Hematoma
Health Care Costs
Breast
Needles
Large-Core Needle Biopsy
Cost Savings
Radar
Preoperative Care
Costs and Cost Analysis
Patient Satisfaction
Cost-Benefit Analysis
Seeds
Magnetic Resonance Imaging
Safety

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Merrill, A. Y., Ochoa, D., Klimberg, V., Hill, E. L., Preston, M., Neisler, K., & Henry-Tillman, R. S. (2018). Cutting Healthcare Costs with Hematoma-Directed Ultrasound-Guided Breast Lumpectomy. Annals of Surgical Oncology, 25(10), 3076-3081. https://doi.org/10.1245/s10434-018-6596-1

Cutting Healthcare Costs with Hematoma-Directed Ultrasound-Guided Breast Lumpectomy. / Merrill, Amelia Y.; Ochoa, Daniela; Klimberg, Vicki; Hill, Erica L.; Preston, Michael; Neisler, Kristen; Henry-Tillman, Ronda S.

In: Annals of Surgical Oncology, Vol. 25, No. 10, 01.10.2018, p. 3076-3081.

Research output: Contribution to journalReview article

Merrill, AY, Ochoa, D, Klimberg, V, Hill, EL, Preston, M, Neisler, K & Henry-Tillman, RS 2018, 'Cutting Healthcare Costs with Hematoma-Directed Ultrasound-Guided Breast Lumpectomy', Annals of Surgical Oncology, vol. 25, no. 10, pp. 3076-3081. https://doi.org/10.1245/s10434-018-6596-1
Merrill, Amelia Y. ; Ochoa, Daniela ; Klimberg, Vicki ; Hill, Erica L. ; Preston, Michael ; Neisler, Kristen ; Henry-Tillman, Ronda S. / Cutting Healthcare Costs with Hematoma-Directed Ultrasound-Guided Breast Lumpectomy. In: Annals of Surgical Oncology. 2018 ; Vol. 25, No. 10. pp. 3076-3081.
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abstract = "Background: Localization of nonpalpable breast lesions for breast-conserving surgery (BCS) remains highly variable and includes needle/wire localization (NL), radioactive seed localization, radar localization, and hematoma-directed ultrasound-guided (HUG) lumpectomy. The superiority of HUG lumpectomy over NL has been demonstrated repeatedly in terms of safety, accuracy, low positive margin rates, cosmesis, and patient satisfaction. In this study, we evaluate the cost effectiveness of HUG lumpectomy over NL for nonpalpable breast lesions. Methods: We performed a retrospective review of 569 patients who underwent lumpectomy at the University of Arkansas for Medical Sciences from May 2014 through December 2017. Lumpectomies were stratified by localization technique, i.e. NL versus HUG. A cost-savings estimate was determined for the HUG localization technique, and a total amount of dollars saved over the study period was calculated. Results: Overall, 569 lumpectomies were performed: 501 (88.0{\%}) via HUG and 68 (12.0{\%}) via NL. Intraoperative ultrasound was used in 566 operations (99.5{\%}). Of the lumpectomies performed by HUG, 190 lesions (33.4{\%}) were visible only on mammogram or breast magnetic resonance imaging prior to diagnostic core needle biopsy (CNB). Cost estimates comparing HUG with NL demonstrated a cost savings of $497.00 per procedure, the cost of preoperative needle localization by a radiologist, and a total of $94,430.00 for the study period. Conclusion: In utilizing HUG lumpectomy, the initial CNB serves as the diagnostic and localization procedure, thus saving time and a painful second procedure on the day of operation. HUG lumpectomy is safe, accurate, reduces healthcare costs, and results in a better patient experience for the surgical removal of nonpalpable breast lesions.",
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AU - Hill, Erica L.

AU - Preston, Michael

AU - Neisler, Kristen

AU - Henry-Tillman, Ronda S.

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