Practice Of Sentinel Lymph Node Biopsy Research Articles

Ductal Carcinoma In Situ with Microinvasion on Core Biopsy: Evaluating Tumor Upstaging Rate, Lymph Node Metastasis Rate, and Associated Predictive Variables.

The role of sentinel lymph node biopsy (SLNB) when ductal carcinoma in situ with microinvasion (DCISM) is identified on core biopsy is unclear. Our aim was to assess the upstage rate to invasive cancer and axillary lymph node metastasis in patients diagnosed with DCISM, and whether predictive variables could be identified that may help inform who would most likely benefit from a surgical axillary evaluation. We performed a retrospective review of 70 patients diagnosed with DCISM on core biopsy. Patients with concomitant or prior invasive cancer were excluded. Demographic, clinical, radiographic, histologic, and treatment data were collected. Fisher's exact test and univariable and multivariable logistic regression were performed to identify variables that may be associated with tumor upstaging and nodal metastasis. Time-to-event distributions were summarized using the Kaplan-Meier method. On final surgical pathology, 49 patients (70%) had a final diagnosis of DCISM or T1mi cancer, whereas 21 patients (30%) were upstaged to measurable invasive cancer (> 1mm). One of 49 patients (2%) with DCISM on final pathology and 4 of 21 patients (19%) with measurable invasive cancer showed sentinel lymph node metastases. Although the upstage rate to measurable invasive cancer in our cohort of patients with DCISM on core biopsy was 30%, findings of a positive SLNB remain low at 7%. No predictive variables were identified to inform whether the routine practice of SLNB may be omitted in some patients with DCISM.

Surgical quality metrics for lymph node staging of intermediate thickness melanoma: A population based study

Background. Variability in compliance with guidelines for lymph node (LN) surgery for melanoma patients has been attributed to controversy about patient selection and quality metrics. Prior data indicate suboptimal practice of sentinel LN biopsy (SLNB) and a trend for omission of LN dissection (LND) for LN+ disease that began well before publication of the MSLT-II trial data. To minimize bias, we studied compliance with ASCO/SSO guidelines in patients for whom there is general agreement, namely T2-T3 (intermediate thickness) melanoma, and analyzed contributing factors and outcomes.

Abstract C31: Exploring disparities in sentinel lymph node biopsy within the Breast Cancer Care in Chicago study

Abstract Background: Lymph node biopsy is a critical component of a diagnostic work-up for patients with invasive breast cancer and is necessary for evaluating the extent and stage of disease so that appropriate treatment can be recommended. The standard procedure prior to the advent of sentinel lymph node biopsy (SLNB) procedures was axillary lymph node dissection (ALND), which is associated with debilitating side effects such as lymphedema. SLNB diffused into practice during the early 2000s and is associated with fewer side effects; for this reason, SLNB has become the standard of care for women diagnosed with invasive breast cancer without clinically palpable lymph node involvement. Using data from the Breast Cancer Care in Chicago study (BCCC), we investigated racial/ethnic disparities in the receipt of SLNB vs. ALND and whether certain tumor, patient, or facility characteristics might help to explain the likelihood of receiving a SLNB. Methods: A total of 989 female patients newly diagnosed with breast cancer were recruited and interviewed for the study. Eligible patients were female, resided in Chicago, had a first primary in situ or invasive breast cancer; were diagnosed between 2005 and 2008 between the ages of 30 and 79 at diagnosis; and self-identified as either non-Latina (nL) White, nL Black or Latina. Of these, 74% (N=731) consented to medical record abstraction and had complete information on receipt of either ALND or SLNB. The racial/ethnic disparity in receipt of SLNB was estimated as a prevalence difference (PD) using logistic regression with marginal based standardization. Mediation analyses were conducted using the method of rescaled coefficients (Karlson, Holm, and Breen). All models were adjusted for age at diagnosis. Results: Roughly half of patients (57%) received a SLNB; nL White women were more likely to receive a SLNB as compared to nL Black and Hispanic women (67% vs 50% and 50%; p=<.001). The prevalence of SNLB was 33%, 75%, 70%, 38% and 20% for stage 0, 1, 2, 3 and 4 breast cancer (p<0.0001) and was higher for ER/PR positive versus negative tumors (p<0.0001) and decreased with increasing tumor grade (p=0.007). SLNB did not vary appreciably for patients who were uninsured, publicly insured or privately insured and SLNB was more common for patients diagnosed at facilities with accreditations from the National Accreditation Program for Breast Centers (NAPBC) and the Commission on Cancer (COC) and less common for patients diagnosed at disproportionate share facilities (p<0.05 for all). After adjusting for age, stage at diagnosis, and tumor characteristics, the disparity in receipt of SLNB was 24 percentage points. In mediation analysis, facility accreditation and disproportionate share status explained 43% of the disparity (p=0.030). Conclusion: During the mid to late 2000s when the practice of SLNB as an alternative to ALND was reaching about half of eligible patients in Chicago, ethnic minority patients were less likely than their nL White counterparts to receive SLNB. Facility accreditation explained a substantial portion of this disparity. Better access and opportunities to go to highly accredited facilities may decrease this disparity. Citation Format: Bethliz Irizarry, Keith Dookeran, Garth Rauscher. Exploring disparities in sentinel lymph node biopsy within the Breast Cancer Care in Chicago study. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr C31.

Abstract P1-01-18: Survey of the Current Practice of Sentinel Lymph Node Biopsy in Latin America

Abstract Background: Despite the fact that breast cancer cases in Latin America (LA) are frequently diagnosed in advanced stages, a significant number of cases are detected early on. Sentinel lymph node biopsy (SLNB) is now the standard of care for nodal staging in early breast cancer and it should be offered to patients even in countries with limited resources. Currently there is limited information regarding practice of SLNB is in LA. The purpose of this study is to explore how SLNB is offered in LA to breast cancer patients when properly indicated, and to investigate the possible obstacles to its implementation. This information would allow us to assess the need for education strategies to expand its use and maintain quality. Methods: An original electronic survey questionnaire was developed to assess self-reported practice in SLNB of all surgeons involved in the management of breast cancer in LA. Moderate to high volume practice was defined as 4 or more breast cancer cases per month or when it comprised more than 25% of the practice. Questionnaires were sent out by e-mail to surgeon members of each of the national surgical associations and/or national mastology societies. For this initial report we selected the following countries: Mexico, Guatemala, Nicaragua, Colombia, Venezuela, Peru, and Uruguay. We present a descriptive analysis of these responses. Results: 330 surgeons responded, of whom 218 (66.1%) were general surgeons and 112 (33.9%) had a subspecialty in breast surgery or surgical oncology. Only 31.8% (105/330) of surgeons reporting to treat breast cancer had a moderate to high caseload. In cities with less than 500,000 inhabitants, breast cancer cases were mainly treated by low volume general surgeons. In larger cities, there were a greater number of specialized surgeons; still a significant number of low volume surgeons are taking care of breast cancer cases. Out of 105 surgeons with moderate to high volume, 93 (88.6%) routinely perform SLNB; of whom more than half (53.8%) perform 5 or more SLNB per month. Nonetheless, 45.2% stated that less than 25% of their caseload was eligible to undergo SLNB. The majority (69.6%) reported using the combined technique (dye and radiotracer). Most (67.9%) learned SLNB technique with a mentor or during fellowship training. When asked about limiting factors to the implementation: 61% highlighted the lack of resources such as gamma probe, nuclear medicine facilities and increased costs as a restrictive factor, and 32.4% pointed out the lack of training opportunities as their main limitation. Just 32 surgeons were involved in SLNB teaching in post-graduate medical training but only 12 of them referred to teach an appropriate number of cases to residents. Conclusion: A significant number of the surgeons treating breast cancer are general surgeons with a low volume of cases but it amounts to a significant number of patients. SLNB is currently been done by surgeons with a moderate to high caseload and/or a sub-specialty. Barriers to implementation appear to be related to scarce resources, lack of training opportunities and low volume of eligible cases. There seems to be a need for increase use of SLNB in LA. Novel strategies to train surgeons and guarantee the quality of their practice are warranted. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P1-01-18.