Utilization of Sentinel Lymph Node Biopsy in Patients with Ductal Carcinoma In Situ Undergoing Mastectomy
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Current guidelines suggest consideration of sentinel lymph node biopsy (SLNB) for patients with ductal carcinoma in situ (DCIS) undergoing mastectomy. Our objective was to identify factors influencing the utilization of SLNB in this population.
We used the Surveillance Epidemiology and End Results database to identify all women with breast DCIS treated with mastectomy from 2000 to 2008. We excluded patients without histologic confirmation, those diagnosed at autopsy, those who had axillary lymph node dissections performed without a preceding SLNB, and those for whom the status of SLNB was unknown. We used multivariate logistic regression reporting odds ratios (OR) and 95 % confidence intervals (CI) to evaluate the relationship of patient- and tumor-related factors to the likelihood of undergoing SLNB.
Of 20,177 patients, 51 % did not receive SLNB. Factors associated with a decreased likelihood of receiving a SLNB included advancing age (OR 0.66; 95 % CI 0.62–0.71), Asian (OR 0.75; CI 0.68–0.83) or Hispanic (OR 0.84; 95 % CI 0.74–0.96) race/ethnicity, and history of prior non-breast (OR 0.57; 95 % CI 0.53–0.61). Factors associated with an increased likelihood of receiving a SLNB included treatment in the east (OR 1.28; 95 % CI 1.17–1.4), intermediate (OR 1.25; 95 % CI 1.11–1.41), high (OR 1.84; 95 % CI 1.62–2.08) grade tumors, treatment after the year 2000, and DCIS size 2–5 cm (OR 1.54; 95 % CI 1.42–1.68) and >5 cm (OR 2.43; 95 % CI 2.16–2.75).
SLNB is increasingly utilized in patients undergoing mastectomy for DCIS, but disparities in usage remain. Efforts at improving rates of SLNB in this population are warranted.
KeywordsSentinel Lymph Node Biopsy Axillary Lymph Node Dissection Logistic Regression Reporting Odds Ratio Regression Reporting Odds Ratio
Supported by Grant Number UL1 RR024146 from the National Center for Research Resources (NCRR) a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NNCRR or NIH. Information on NCRR is available athttp://www.ncrr.nih.gov/. Information on Re-engineering the Clinical Research Enterprise can be obtained from http://nihroadmap.nih.gov/clinicalresearch/overview-translational.asp.
- 10.ACR-ACS-CAP-SSO Practice Guideline for the Management of Ductal Carcinoma In-Situ of the Breast. In http://www.acr.org/SecondaryMainMenuCategories/quality_safety/guidelines/breast/DCIS.pdf (ed), 2006.