Staging MR Lymphangiography of the Axilla for Early Breast Cancer: Cost-Effectiveness Analysis
ABSTRACT The purpose of this study was to compare the cost-effectiveness of MR lymphangiography-based strategies with that of sentinel lymph node (SLN) biopsy alone in the axillary staging of early breast cancer.
A decision-analytic Markov Model was developed to estimate quality-adjusted life expectancy and lifetime costs among 61-year-old women with clinically node-negative early breast cancer. Three axillary staging strategies were compared: MR lymphangiography alone, combined MR lymphangiography-SLN biopsy, and SLN biopsy alone. The model incorporated treatment decisions, outcome, and costs consequent to axillary staging results. An incremental cost-effectiveness analysis was performed to compare strategies. The effect of changes in key parameters on results was addressed in sensitivity analysis.
In the base-case analysis, combined MR lymphangiography-SLN biopsy was associated with the highest quality-adjusted life expectancy (13.970 years) and cost ($63,582), followed by SLN biopsy alone (13.958 years, $62,462) and MR lymphangiography alone (13.957 years, $61,605). MR lymphangiography-SLN biopsy and SLN biopsy both were associated with higher life expectancy and cost relative to those of MR lymphangiography. MR lymphangiography-SLN biopsy, however, was associated with greater overall life expectancy and greater added life expectancy per dollar than was SLN biopsy. SLN biopsy alone therefore was not considered cost-effective, but MR lymphangiography and MR lymphangiography-SLN biopsy remained competing choices. Preference of MR lymphangiography strategies was most dependent on the sensitivity of MR lymphangiography and SLN biopsy and on the quality-of-life consequences of SLN biopsy and axillary lymph node dissection, but otherwise was stable across most parameter ranges tested.
From a cost-effectiveness perspective, MR lymphangiography strategies for axillary staging of early breast cancer are preferred over SLN biopsy alone. The sensitivity of MR lymphangiography is a critical determinant of the cost-effectiveness of MR lymphangiography strategies and merits further investigation in the care of patients with early breast cancer.
Conference Paper: Soft constraint iterative reconstruction from noisy projections[Show abstract] [Hide abstract]
ABSTRACT: Soft constraints are introduced in an iterative projection approach, in order to make the set of constraints compatible for the case of noisy measurements. The degrees of freedom in the design are then used to arrive at a computationally simple form of the soft constraint algorithm. Simulation shows that the true solution is still feasible under noisy conditions, a property lost with the use of hard constraint algorithms.Acoustics, Speech, and Signal Processing, IEEE International Conference on ICASSP '84.; 04/1984
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ABSTRACT: OBJECTIVE: This commentary provides a brief overview of cost-effectiveness analysis, which is increasingly applied in radiologic research. The purpose is to familiarize readers with the basic concepts in this topic and to provide help in appraising original articles in this area of research, as featured in this issue of the AJR. CONCLUSION:Despite some limitations, decision-analytic modeling provides a useful tool for cost-effectiveness analysis in emerging technologies and helps to direct future research and the practice of radiology.American Journal of Roentgenology 12/2008; 191(5):1320-2. DOI:10.2214/AJR.08.1514 · 2.74 Impact Factor
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ABSTRACT: To retrospectively assess the frequency of internal mammary lymph nodes (IMNs) in patients after mastectomy and tissue-expander reconstruction. Statistical analysis was performed for all available data in patients with mastectomy and tissue-expander reconstruction from 2004-2007 (study group). The data were compared with that of a control population with mastectomy who did not have reconstruction (control group). Patients with recurrent breast cancers, previous breast reconstruction, surgeries performed at outside hospitals, no available pre- or postoperative computed tomography (CT) or magnetic resonance imaging (MRI) data, or inadequate imaging follow-up were excluded. There were eight patients in the study group (median age 50.5 years, seven breast cancers), and eight patients in the control group (median age 52 years, seven breast cancers). No patients had IMNs on their preoperative imaging examinations. New IMNs were present in postoperative imaging in seven of eight patients (7/8, 87.5%) in the study group. All of them were stable or decreased in size on subsequent imaging examinations. None of the patients in the control group had IMNs (0/8). IMNs are common on imaging after mastectomy and tissue-expander placement. The IMNs decreased or remained stable on follow-up imaging and may represent reactive nodes.Clinical Radiology 06/2010; 65(6):453-9. DOI:10.1016/j.crad.2010.01.015 · 1.66 Impact Factor