Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, United States; Quality Integration Committee, Commission on Cancer, American College of Surgeons, United States.
Quality Integration Committee, Commission on Cancer, American College of Surgeons, United States.
Am J Surg. 2020 Sep;220(3):654-659. doi: 10.1016/j.amjsurg.2020.01.014. Epub 2020 Jan 13.
The role of sentinel lymph node biopsy (SLNB) for patients with ductal carcinoma in-situ (DCIS) is limited given the rarity of nodal metastasis in non-invasive disease. Although SLNB is typically a safe procedure, there are potential complications and associated costs. The purpose of this study is to assess national surgical practice patterns and clinical outcomes with respect to the use of SLNB for DCIS in patients undergoing breast conserving surgery (BCS).
Case-level data from the National Cancer Data Base (NCDB) was assessed to identify adult patients ≥ 18 with DCIS, who underwent BCS and SLNB. Patient demographics and hospital characteristics were grouped for analytic purposes. A multivariate analysis was performed for patient and hospital characteristics.
We identified 15,422 patients with DCIS undergoing BCS in 2015, of which 2,698 (18%) underwent SLNB. A multivariate analysis demonstrated a significant association between greater frequency of SLNB in patients age range of 60-69, receipt of care at a community facility, and higher nuclear grade DCIS. Positive sentinel nodes metastasis was identified in 0.9% patients undergoing BCS and SLNB for DCIS.
The role of SLNB in patients with DCIS undergoing BCS is limited and does not routinely provide meaningful information or benefit to clinical management. Despite this, nearly one in five patients undergoing BCS for DCIS had lymph node sampling performed. Given the potential increased morbidity and financial implications, this finding represents an opportunity for further education and improvement in patient selection for SLNB.
鉴于非浸润性疾病中淋巴结转移的罕见性，前哨淋巴结活检（SLNB）在导管原位癌（DCIS）患者中的作用有限。尽管 SLNB 通常是一种安全的手术，但存在潜在的并发症和相关费用。本研究的目的是评估全国范围内在接受保乳手术（BCS）的 DCIS 患者中使用 SLNB 的手术实践模式和临床结果。
从国家癌症数据库（NCDB）评估病例水平数据，以确定≥18 岁患有 DCIS 并接受 BCS 和 SLNB 的成年患者。根据分析目的对患者人口统计学和医院特征进行分组。对患者和医院特征进行多变量分析。
我们在 2015 年确定了 15422 例接受 BCS 的 DCIS 患者，其中 2698 例（18%）接受了 SLNB。多变量分析表明，60-69 岁患者 SLNB 频率较高、在社区机构接受治疗以及核级较高的 DCIS 与 SLNB 更相关。在接受 BCS 和 SLNB 治疗 DCIS 的患者中，有 0.9%的患者发现前哨淋巴结转移阳性。
SLNB 在接受 BCS 的 DCIS 患者中的作用有限，通常不会为临床管理提供有意义的信息或获益。尽管如此，近五分之一接受 BCS 治疗 DCIS 的患者进行了淋巴结取样。鉴于潜在的发病率增加和经济影响，这一发现为进一步教育和改善 SLNB 的患者选择提供了机会。
