Abstract
BackgroundThe National Comprehensive Cancer Network (NCCN) and the American Society of Clinical Oncology (ASCO) provide guidelines regarding axillary nodal evaluation in ductal carcinoma in situ (DCIS), but data regarding national compliance with these guidelines remains incomplete.MethodsWe conducted a retrospective review of the National Cancer Data Base (NCDB) analyzing all surgical approaches to axillary evaluation in patients with DCIS. Logistic regression analysis was used to assess the multivariate relationship between patient demographics, clinical characteristics, and probability of axillary evaluation.ResultsWe identified 88,083 patients diagnosed with DCIS between 1998 and 2011; 31,912 (37%) underwent total mastectomy (TM) and 55,349 (63%) had breast conserving therapy (BCT). Axillary evaluation increased from 44.4% in 1998 to 63.3% in 2011. In TM patients, axillary evaluation increased from 74.3% in 1998 to 93.4% in 2011. This correlated with an increase in sentinel lymph node biopsy (SLNB) from 24.3 to 77.1%, while ALND decreased from 50.0 to 16.3% (p <0.01). In BCT patients, evaluation increased from 20.1 to 43.9%; SLNB increased from 7.2 to 39.4% and ALND decreased from 12.9 to 4.5%. Factors associated with axillary nodal evaluation in BCT patients included practice type and facility location. Among TM patients, use of axillary lymph node dissection (ALND) for axillary staging was associated with earlier year of diagnosis, black race, and older age, as well as community practice setting and practice location in the Southern US.ConclusionsCompliance with national guidelines regarding axillary evaluation in DCIS remains varied. Practice type and location-based differences suggest opportunities for education regarding the appropriate use of axillary nodal evaluation in patients with DCIS.
Highlights
The National Comprehensive Cancer Network (NCCN) and the American Society of Clinical Oncology (ASCO) provide guidelines regarding axillary nodal evaluation in ductal carcinoma in situ (DCIS), but data regarding national compliance with these guidelines remains incomplete
Data source The National Cancer Data Base (NCDB) represents a collaborative repository of patient data drawn from the American Cancer Society (ACS) and the Commission on Cancer (COC) of the American College of Surgeons Since 1989, the NCDB has functioned as a nationwide oncology outcomes database for more than 1,500 COC-accredited cancer programs in the United States (US) and Puerto Rico, and contains approximately 29 million total records
Of the 88,083 patients diagnosed with DCIS from 1998 to 2011 who met inclusion criteria for our analysis, 31,912 of these patients (37%) underwent total mastectomy (TM), and 55,349 patients (63%) underwent breast conserving therapy (BCT)
Summary
The National Comprehensive Cancer Network (NCCN) and the American Society of Clinical Oncology (ASCO) provide guidelines regarding axillary nodal evaluation in ductal carcinoma in situ (DCIS), but data regarding national compliance with these guidelines remains incomplete. Since the early 1970s, the incidence of DCIS has increased from 1.8 per 100,000 women to 32.5 per 100,000 women in the mid-2000s [3] This represents a fivefold increase in diagnoses over time, and largely has resulted from widespread adoption of screening mammography: more than 80% of lesions are detected through this modality [4]. The rate and appropriateness of axillary lymph node evaluation in surgical procedures for DCIS recently has been investigated [7,8,9,10,11]. Many of these studies acknowledged that while DCIS represents in-situ disease and the vast majority
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
