The implementation of a noninvasive lymph node staging (NILS) preoperative prediction model is cost effective in primary breast cancer

Breast Cancer Res Treat. 2022 Aug;194(3):577-586. doi: 10.1007/s10549-022-06636-x. Epub 2022 Jul 5.


Purpose: The need for sentinel lymph node biopsy (SLNB) in clinically node-negative (cN0) patients is currently questioned. Our objective was to investigate the cost-effectiveness of a preoperative noninvasive lymph node staging (NILS) model (an artificial neural network model) for predicting pathological nodal status in patients with cN0 breast cancer (BC).

Methods: A health-economic decision-analytic model was developed to evaluate the utility of the NILS model in reducing the proportion of cN0 patients with low predicted risk undergoing SLNB. The model used information from a national registry and published studies, and three sensitivity/specificity scenarios of the NILS model were evaluated. Subgroup analysis explored the outcomes of breast-conserving surgery (BCS) or mastectomy. The results are presented as cost (€) and quality-adjusted life years (QALYs) per 1000 patients.

Results: All three scenarios of the NILS model reduced total costs (-€93,244 to -€398,941 per 1000 patients). The overall health benefit allowing for the impact of SLNB complications was a net health gain (7.0-26.9 QALYs per 1000 patients). Sensitivity analyses disregarding reduced quality of life from lymphedema showed a small loss in total health benefits (0.4-4.0 QALYs per 1000 patients) because of the reduction in total life years (0.6-6.5 life years per 1000 patients) after reduced adjuvant treatment. Subgroup analyses showed greater cost reductions and QALY gains in patients undergoing BCS.

Conclusion: Implementing the NILS model to identify patients with low risk for nodal metastases was associated with substantial cost reductions and likely overall health gains, especially in patients undergoing BCS.

Keywords: Artificial neural network; Axillary lymph nodes; Breast neoplasm; Cost-effectiveness; Staging.

MeSH terms

  • Axilla / pathology
  • Breast Neoplasms* / pathology
  • Breast Neoplasms* / surgery
  • Cost-Benefit Analysis
  • Female
  • Humans
  • Lymph Node Excision / methods
  • Lymph Nodes / pathology
  • Lymph Nodes / surgery
  • Lymphatic Metastasis / pathology
  • Mastectomy
  • Neoplasm Staging
  • Quality of Life
  • Sentinel Lymph Node Biopsy / methods
  • Sentinel Lymph Node* / pathology