Utilization of sentinel lymph node biopsy in patients with ductal carcinoma in situ undergoing mastectomy

Dhruvil R. Shah, Robert J Canter, Vijay P. Khatri, Richard J Bold, Anthony D. Yang, Steve R. Martinez

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: 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. Methods: 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. Results: 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). Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)24-30
Number of pages7
JournalAnnals of Surgical Oncology
Volume20
Issue number1
DOIs
StatePublished - Jan 2013

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Sentinel Lymph Node Biopsy
Carcinoma, Intraductal, Noninfiltrating
Mastectomy
Odds Ratio
Confidence Intervals
Lymph Node Excision
Hispanic Americans
Population
Autopsy
Neoplasms
Epidemiology
Logistic Models
Databases
Guidelines

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Utilization of sentinel lymph node biopsy in patients with ductal carcinoma in situ undergoing mastectomy. / Shah, Dhruvil R.; Canter, Robert J; Khatri, Vijay P.; Bold, Richard J; Yang, Anthony D.; Martinez, Steve R.

In: Annals of Surgical Oncology, Vol. 20, No. 1, 01.2013, p. 24-30.

Research output: Contribution to journalArticle

Shah, Dhruvil R. ; Canter, Robert J ; Khatri, Vijay P. ; Bold, Richard J ; Yang, Anthony D. ; Martinez, Steve R. / Utilization of sentinel lymph node biopsy in patients with ductal carcinoma in situ undergoing mastectomy. In: Annals of Surgical Oncology. 2013 ; Vol. 20, No. 1. pp. 24-30.
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abstract = "Background: 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. Methods: 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. Results: 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). Conclusions: 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.",
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AU - Yang, Anthony D.

AU - Martinez, Steve R.

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AB - Background: 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. Methods: 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. Results: 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). Conclusions: 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.

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