CMAnalyzing, Zevenaar, the Netherlands.
Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, the Netherlands.
PLoS One. 2022 Jun 6;17(6):e0269551. doi: 10.1371/journal.pone.0269551. eCollection 2022.
There is a large variation between Dutch hospitals in the use of Sentinel Lymph Node Biopsy (SLNB) in patients with a biopsy diagnosis of Ductal Carcinoma in Situ. The aim of our study was to investigate whether this variation might be explained by preferences of surgeons, organisational factors or the influence of patients preferences.
A cross-sectional web survey was conducted among 260 Dutch oncological/breast surgeons. Preferences of surgeons and the influence of the patients' preferences were determined by means of best-worst scaling (BWS) of profile case scenarios and by ranking risk factors. The survey also explored organisational questions, the reported use of diagnostic techniques and influences on the decision.
The BWS scenarios were completed by 57 surgeons. The most important reasons for performing SLNB were a suspected invasive component and DCIS grade 3. In the ranking, these were also the first and second most important factor, followed by the size of the lesion and a mass on mammogram. In 58% to 70% of the scenarios, the surgeons would not change their decisions on the use of SLNB if the patient's chose differed. No organisational factor was significantly associated with the reported use of SLNB.
The inter-hospital variation in the use of SLNB could not be attributed to organisational factors or surgeons' preferences for risk factors. The risk factors that most surgeons reported as reasons for performing SLNB are consistent with the factors described in the Dutch treatment guideline for the use of SLNB.
荷兰各家医院在诊断为乳腺导管原位癌（DCIS）的患者中使用前哨淋巴结活检（SLNB）的做法存在较大差异。本研究旨在调查这种差异是否可以用外科医生的偏好、组织因素或患者偏好的影响来解释。
对 260 名荷兰肿瘤/乳腺外科医生进行了横断面网络调查。通过对病例特征进行最佳最差分级（BWS）和对风险因素进行排序，确定了外科医生的偏好及其对患者偏好的影响。该调查还探讨了组织问题、诊断技术的应用情况以及对决策的影响。
57 名外科医生完成了 BWS 病例。进行 SLNB 的最主要原因是怀疑存在浸润性成分和 DCIS 分级 3。在排名中，这也是最重要的第一和第二因素，其次是病变大小和乳房 X 线照相术上的肿块。在 58%至 70%的情况下，如果患者的选择不同，外科医生不会改变对 SLNB 使用的决定。没有组织因素与 SLNB 的报告使用显著相关。
SLNB 使用的医院间差异不能归因于组织因素或外科医生对风险因素的偏好。大多数外科医生报告的进行 SLNB 的原因是一致的，与荷兰 SLNB 使用治疗指南中描述的因素一致。
