Hung Peiyin, Wang Shi-Yi, Killelea Brigid K, Mougalian Sarah S, Evans Suzanne B, Sedghi Tannaz, Gross Cary P
Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC.
Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT.
JNCI Cancer Spectr. 2019 Aug 7;3(4):pkz052. doi: 10.1093/jncics/pkz052. eCollection 2019 Dec.
The use of sentinel lymph node biopsy (SLNB) for ductal carcinoma in situ (DCIS) is controversial. Using population-cohort data, we examined whether SLNB improves long-term outcomes among patients with DCIS who underwent breast-conserving surgery. We identified 12 776 women aged 67-94 years diagnosed during 2001-2013 with DCIS who underwent breast-conserving surgery from the US Surveillance, Epidemiology, and End Results-Medicare dataset, 1992 (15.6%) of whom underwent SLNB (median follow-up: 69 months). Tests of statistical significance are two-sided. Patients with and without SLNB did not differ statistically significantly regarding treated recurrence (3.9% vs 3.7%; .62), ipsilateral invasive occurrence (1.4% vs 1.7%, .33), or breast cancer mortality (1.0% vs 0.9%, .86). With Mahalanobis-matching and competing-risks survival analyses, SLNB was not statistically significantly associated with treated recurrence, ipsilateral invasive occurrence, or breast cancer mortality ( ≥ .27). Our findings do not support the routine performance of SLNB for older patients with DCIS amenable to breast conservation.
前哨淋巴结活检（SLNB）用于原位导管癌（DCIS）存在争议。利用人群队列数据，我们研究了SLNB是否能改善接受保乳手术的DCIS患者的长期预后。我们从美国监测、流行病学和最终结果 - 医疗保险数据集（1992年）中识别出12776名年龄在67 - 94岁之间、于2001 - 2013年被诊断为DCIS并接受保乳手术的女性，其中1992名（15.6%）接受了SLNB（中位随访时间：69个月）。统计学显著性检验为双侧检验。接受和未接受SLNB的患者在治疗后复发（3.9%对3.7%；P = 0.62）、同侧浸润性发病（1.4%对1.7%，P = 0.33）或乳腺癌死亡率（1.0%对0.9%，P = 0.86）方面无统计学显著差异。通过马氏匹配和竞争风险生存分析，SLNB与治疗后复发、同侧浸润性发病或乳腺癌死亡率无统计学显著关联（P≥0.27）。我们的研究结果不支持对适合保乳的老年DCIS患者常规进行SLNB。
