Prevalence and Consequences of Axillary Lymph Node Dissection in the Era of Sentinel Lymph Node Biopsy for Breast Cancer

Laud, Purushottam W.; Pezzin, Liliana E.; McGinley, Emily L.; Wozniak, Erica; Sparapani, Rodney; Nattinger, Ann B.

doi:10.1097/mlr.0000000000000832

Cited by 13 publications

(12 citation statements)

References 37 publications

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“…Initiatives such as Choosing Wisely Canada have attempted to increase awareness about this topic in recent years [35]. In our study, we found that 5.8% of women in Manitoba with node-negative cancer underwent an ALND, but that the number varied greatly by surgery geographic locations; other studies from other jurisdictions found this number to be as high as 49% [36]. Therefore, Manitoba meets the minimum standard published by EUSOMA as well as the target, but on a global scale, but some centers are falling well behind this benchmark.…”

Section: Discussionmentioning

confidence: 56%

“…Breast-conserving surgery was the most common procedure (66.7%) followed by mastectomy without immediate reconstruction (22.8%) and mastectomy with immediate reconstruction (10.5%). The youngest age group (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39) underwent the highest percentage of mastectomy with immediate reconstruction (36.1%; 95% CI: 27.9 to 44.3). This percentage decreased with increasing age.…”

Section: Surgical Treatment Patternsmentioning

confidence: 99%

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Assessment of Breast Cancer Surgery in Manitoba: A Descriptive Study

et al. 2021

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Background: Variation in breast cancer surgical practice patterns can lead to poor clinical outcomes. It is important to measure and reduce variation to ensure all women diagnosed with breast cancer receive equitable, high-quality care. A population-based assessment of the variation in breast cancer surgery treatment and quality has never been conducted in Manitoba. The objective of this study was to assess the variation in surgical treatment patterns, quality of care, and post-operative outcomes for women diagnosed with invasive breast cancer. Methods: This descriptive study used data from the Manitoba Cancer Registry, Hospital Discharge Abstracts Database, Medical Claims, Manitoba Health Insurance Registry, and Statistics Canada. The study included women in Manitoba aged 20+ and diagnosed with invasive breast cancer between 1 January 2010 and 31 December 2014. Results: Axillary lymph node dissection (ALND) for node-negative disease ranged from 11.8% to 33.3%, timeliness (surgery within 30 days of consult) ranged from 33.3% to 60.2%, and re-excision ranged from 14.7% to 24.6% between health authorities. Women who underwent breast-conserving surgery had the shortest median length of stay and women who underwent mastectomy with immediate reconstruction had the longest median length of stay. In-hospital post-operative complications were higher among women who received mastectomy with immediate reconstruction (9.9%). Conclusion: Variation in surgical treatment, quality, and outcomes exist in Manitoba. The findings from this study can be used to inform cancer service delivery planning, quality improvement efforts, and policy development. Influencing data-driven change at the health system level is paramount to ensuring Manitobans receive the highest quality of care.

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Section: Discussionmentioning

confidence: 56%

Section: Surgical Treatment Patternsmentioning

confidence: 99%

Assessment of Breast Cancer Surgery in Manitoba: A Descriptive Study

et al. 2021

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“…Sentinel lymph node biopsy (SLNB) serves as an optimal choice for those without clinical or radiological evidence of ALN metastasis. It has been considered to be an ideal procedure for patients whose sentinel lymph node (SLN) are negative (4, 5) or those with 1–2 positive SLN (6, 7). However, second procedure of ALND or radiotherapy is unavoidable to adequately deal with axilla if SLN metastasis was found (8).…”

Section: Introductionmentioning

confidence: 99%

“…MDCT can obtain high-quality multiplanar images in fast scan time and allow three-dimensional reconstruction (17). Furthermore, preoperative MDCT can be performed with the patient in the supine position, which facilitates simultaneous localization of the lesion, and evaluation of its extent, as well as examination of the skin, chest wall, and regional lymph nodes, including both axillae, internal mammary, and supraclavicular chains (5, 8, 18). However, preoperative MDCT for evaluating ALN status in patients with breast cancer remains under-investigated (18, 19).…”

Section: Introductionmentioning

confidence: 99%

Predictive Value of Preoperative Multidetector-Row Computed Tomography for Axillary Lymph Nodes Metastasis in Patients With Breast Cancer

et al. 2019

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Introduction: Axillary lymph nodes (ALN) status is an essential component in tumor staging and treatment planning for patients with breast cancer. The aim of present study was to evaluate the predictive value of preoperative multidetector-row computed tomography (MDCT) for ALN metastasis in breast cancer patients.Methods: A total of 148 cases underwent preoperative MDCT examination and ALN surgery were eligible for the study. Logistic regression analysis of MDCT variates was used to estimate independent predictive factors for ALN metastasis. The prediction of ALN metastasis was determined with MDCT variates through receiver operating characteristic (ROC) analysis.Results: Among the 148 cases, 61 (41.2%) cases had ALN metastasis. The cortical thickness in metastatic ALN was significantly thicker than that in non-metastatic ALN (7.5 ± 5.0 mm vs. 2.6 ± 2.8 mm, P < 0.001). Multi-logistic regression analysis indicated that cortical thickness of >3 mm (OR: 12.32, 95% CI: 4.50–33.75, P < 0.001) and non-fatty hilum (OR: 5.38, 95% CI: 1.51–19.19, P = 0.009) were independent predictors for ALN metastasis. The sensitivity, specificity and AUC of MDCT for ALN metastasis prediction based on combined-variated analysis were 85.3%, 87.4%, and 0.893 (95% CI: 0.832–0.938, P < 0.001), respectively.Conclusions: Cortical thickness (>3 mm) and non-fatty hilum of MDCT were independent predictors for ALN metastasis. MDCT is a potent imaging tool for predicting ALN metastasis in breast cancer. Future prospective study on the value of contrast enhanced MDCT in preoperative ALN evaluation is warranted.

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“…Accurate assessment of ALN disease burden is vital in staging breast cancer, which guides multidisciplinary treatment decision making nowadays [ 2 , 3 ]. Sentinel lymph node (SLN) biopsy (SLNB) is now widely used as the gold standard for axillary staging in clinically node-negative breast cancer in National Comprehensive Cancer Network (NCCN) guidelines [ 4 ], which reduces the complications of lymphedema and other arm morbidity to a certain extent compared with axillary lymph node dissection (ALND) [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Imaging features of sentinel lymph node mapped by multidetector-row computed tomography lymphography in predicting axillary lymph node metastasis

Zhu

et al. 2021

BMC Med Imaging

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Introduction Accurately assessing axillary lymph node (ALN) status in breast cancer is vital for clinical decision making and prognosis. The purpose of this study was to evaluate the predictive value of sentinel lymph node (SLN) mapped by multidetector-row computed tomography lymphography (MDCT-LG) for ALN metastasis in breast cancer patients. Methods 112 patients with breast cancer who underwent preoperative MDCT-LG examination were included in the study. Long-axis diameter, short-axis diameter, ratio of long-/short-axis and cortical thickness were measured. Logistic regression analysis was performed to evaluate independent predictors associated with ALN metastasis. The prediction of ALN metastasis was determined with related variables of SLN using receiver operating characteristic (ROC) curve analysis. Results Among the 112 cases, 35 (30.8%) cases had ALN metastasis. The cortical thickness in metastatic ALN group was significantly thicker than that in non-metastatic ALN group (4.0 ± 1.2 mm vs. 2.4 ± 0.7 mm, P < 0.001). Multi-logistic regression analysis indicated that cortical thickness of > 3.3 mm (OR 24.53, 95% CI 6.58–91.48, P < 0.001) had higher risk for ALN metastasis. The best sensitivity, specificity, negative predictive value(NPV) and AUC of MDCT-LG for ALN metastasis prediction based on the single variable of cortical thickness were 76.2%, 88.5%, 90.2% and 0.872 (95% CI 0.773–0.939, P < 0.001), respectively. Conclusion ALN status can be predicted using the imaging features of SLN which was mapped on MDCT-LG in breast cancer patients. Besides, it may be helpful to select true negative lymph nodes in patients with early breast cancer, and SLN biopsy can be avoided in clinically and radiographically negative axilla.

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Prevalence and Consequences of Axillary Lymph Node Dissection in the Era of Sentinel Lymph Node Biopsy for Breast Cancer

Cited by 13 publications

References 37 publications

Assessment of Breast Cancer Surgery in Manitoba: A Descriptive Study

Assessment of Breast Cancer Surgery in Manitoba: A Descriptive Study

Predictive Value of Preoperative Multidetector-Row Computed Tomography for Axillary Lymph Nodes Metastasis in Patients With Breast Cancer

Imaging features of sentinel lymph node mapped by multidetector-row computed tomography lymphography in predicting axillary lymph node metastasis

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