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Beyond the Clinical Trials: How Often Is Sentinel Lymph Node Dissection Performed for Breast Cancer?

¹ Robert Wood Johnson VA Clinical Scholars Program, 911 Broxton Avenue, 3rd Floor, Los Angeles, California 90024
² Department of Surgery, UCLA School of Medicine, 10833 Le Conte Avenue, CHS, Room 72-215, Los Angeles, California 90095
³ Department of Surgery, UCSF School of Medicine, 1600 Divisadero Street, Box 1710, San Francisco, California 94143
⁴ Department of Surgery, West Los Angeles Veterans Affairs Medical Center, 11301 Wilshire Boulevard, Building 304, Room E3-207, Los Angeles, California 90073

Correspondence: Address correspondence and reprint requests to: Melinda A. Maggard, MD, Department of Surgery, UCLA School of Medicine, 10833 Le Conte Avenue, CHS, Room 72-215, Los Angeles, CA 90095; E-mail: mmaggard{at}mednet.ucla.edu

Background: Sentinel lymph node dissection (SLND) has been shown to be a reasonable treatment option for early-stage breast cancer. Until recently, SLND was limited to clinical trials. Because this technique is now offered outside of trials, its prevalence is unknown.

Methods: All patients with stage I or II breast cancer in the Surveillance, Epidemiology, and End Results national cancer registry (1998–2000) were evaluated. Data were collected for demographics, tumor characteristics, surgical resection, lymph node evaluation (SLND or complete axillary dissection), registry site, and year of diagnosis. Multivariate regression analysis was performed to identify predictors for receiving SLND.

Results: A total of 54,772 patients diagnosed with breast cancer had undergone surgical lymph node evaluation; 27.2% patients with stage I disease underwent SLND, as compared with 22.7% for stage II. Older patients and minority groups were less likely to receive SLND. Receipt of SLND varied by registry site (7.9%–32.7%). Multivariate regression showed that older patients had lower odds of receiving SLND (60–69 years: odds ratio, .73; P < .0001) as compared with younger patients. Additionally, blacks, Hispanics, and Asians had lower odds of receiving SLND (odds ratio of .64, .58, and .80, respectively; P < .0001). SLND use increased over the 3 years in the study (P < .0001).

Conclusions: This population-based analysis showed relatively infrequent use of SLND for early-stage breast cancer. These results suggest a slow transition of this procedure from clinical trials into the community. Future work should be targeted at improving the rate at which patients receive this procedure, particularly for elderly and minority groups and low-use regions.

Key Words: Breast cancer • Administrative data • Sentinel lymph node dissection • Quality of care

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