Abstract
The standard of care for inflammatory breast cancer (IBC) is neoadjuvant chemotherapy, total mastectomy with axillary lymph node dissection (ALND), and postmastectomy radiation therapy. Existing studies suggest that sentinel lymph node biopsy (SLNB) may not be reliable in IBC. The use and frequency of SLNB in women with IBC is not well characterized. To determine the frequency and temporal trend of SLNB in patients with IBC. This retrospective cohort study used the National Cancer Database, a nationwide hospital-based cancer registry, and included women who were diagnosed with nonmetastatic IBC and underwent axillary surgery from 2012 to 2017. Data were analyzed from January 2021 to May 2021. Any SLNB, including SLNB alone and SLNB followed by ALND, and ALND alone. Scatterplot fit with a linear regression model were used to evaluate the yearly increase of any SLNB use. Multivariable logistic regression models to evaluate the association of study variables with the outcome of any SLNB. This study included a total of 1096 women (mean [SD] age, 56.1 [12.9] years) who were 18 years or older with nonmetastatic IBC diagnosed between 2012 and 2017. Of the 186 of 1096 women (17%) who received any SLNB, 137 (73.7%) were White individuals; and of the 910 of 1096 women (83%) who received an ALND only, 676 (74.3%) were White individuals. Among women undergoing any SLNB, 119 of 186 (64%) did not undergo a completion ALND. There was a statistically significant increasing trend in the use of SLNB from 2012 to 2017 (22 of 205 patients [11%] vs 32 of 148 patients [22%]; P = .004). In multivariable analysis, the use of SLNB was associated with diagnosis year (2017 vs 2012; odds ratio [OR], 2.26; 95% CI, 1.26-4.20), clinical nodal status (cN3 vs 0; OR, 0.39; 95% CI, 0.22-0.67), and receipt of reconstructive surgery (OR, 1.80; 95% CI, 1.09-2.96). The findings of this cohort study suggest that there is frequent and increasing use of SLNB in patients with IBC that is not evidence-based or supported by current treatment guidelines.
Highlights
Inflammatory breast cancer (IBC) is an aggressive type of cancer accounting for 1% to 6% of all breast cancers diagnosed in the US per year.[1]
The use of sentinel lymph node biopsy (SLNB) was associated with diagnosis year (2017 vs 2012; odds ratio [OR], 2.26; 95% CI, 1.26-4.20), clinical nodal status, and receipt of reconstructive surgery (OR, 1.80; 95% CI, 1.09-2.96)
Of the 1096 women included, 186 (17%) received any SLNB, and among individuals undergoing any SLNB, 119 of 186 (64%) did not undergo a completion axillary lymph node dissection (ALND). Compared with those undergoing an ALND, individuals undergoing any SLNB had a later date of diagnosis, earlier clinical nodal stage (46 of 186 [24.7%] vs 124 of 910 [13.6%] at clinical node stage 0), and were more likely to undergo a partial mastectomy (10 of 186 [5.4%] vs 11 of 910 [1.2%])
Summary
Inflammatory breast cancer (IBC) is an aggressive type of cancer accounting for 1% to 6% of all breast cancers diagnosed in the US per year.[1]. The standard of care for IBC is trimodality therapy with neoadjuvant chemotherapy, total mastectomy with axillary lymph node dissection (ALND), and postmastectomy radiation therapy. This approach is associated with 5-year overall survival rates of 46% to 51%, with trimodality therapy being a statistically significant predictor of overall survival.[5,6,7] ALND is recommended for all patients with IBC regardless of clinical nodal status or response to neoadjuvant chemotherapy.[8] While sentinel lymph node biopsy (SLNB) is increasingly used in noninflammatory breast cancer, IBC has a unique clinicopathology characterized by invasion into the dermal lymphatics that limits the applicability and suitability of SLNB. We examine the frequency and temporal trend of SLNB in patients with IBC in the US
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