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Measuring the Quality of Sentinel Lymph Node Biopsy (SLNB) for Breast Cancer: A Population-Based Evaluation

Annals of Surgical Oncology volume 20, pages 615–619 (2013)Cite this article

Abstract

Background

The quality SLNB for breast cancer has never been evaluated on a population level. We previously developed SLNB quality indicators (QIs) and measured them at a single institution. The objective of this study was to measure SLNB quality at a population level.

Methods

Patients with a breast cancer diagnosis in Ontario who had axillary surgery between January 1 and December 31, 2005 were identified from the Ontario Cancer Registry. The cohort of patients who underwent a SLNB was determined from institutional administrative datasets and by primary chart abstraction. Data for measuring 8 QIs was abstracted. The influence of patient, provider, and institutional characteristics was determined using generalized estimating equations (GEEs) to account for patient clustering within hospitals.

Results

A total of 2323 breast cancer patients were confirmed to have undergone a SLNB. The QI measurements for SLN identification and the timing of SLNB (alongside primary tumor resection) were high, exceeding 90%. The proportion of cases associated with appropriate pathology evaluation and reporting were modest. Hospital volume of breast cases, urban or rural, and academic versus community designations did not influence quality. Younger patient age (p = .002) and number of nodes removed >1 (p =.008) were significant predictors of node positivity. Consequently, the rate of completion axillary lymph node dissection (cALND) rose with increasing metastatic burden and decreasing patient age.

Conclusions

The quality of SLNB at a population level was generally high. Further evaluation is required, particularly in determining how to improve SLNB pathology evaluation, and reporting.

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References

  1. Institute of Medicine Committee on the National Quality Report on Health Care Delivery: Envisioning the National Health Care Quality Report, Washington, DC; 2001.

  2. Desch CE, McNiff KK, Schneider EC, Schrag D, McClure J, Lepisto E, et al. American Society of Clinical Oncology/National Comprehensive Cancer Network Quality Measures. J Clin Oncol. 2008;26:3631–7.

    PubMed  Article  Google Scholar 

  3. ASCO/NCCN Quality Measures: Breast and Colorectal Cancers. American Society of Clinical Oncology and National Comprehensive Cancer Network; 2007.

  4. Lyman GH, Giuliano AE, Somerfield MR, Benson AB III, Bodurka DC, Burstein HJ, et al. American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol. 2005;23:7703–20.

    PubMed  Article  Google Scholar 

  5. George R, Quan ML, McCready DR, McLeod R, Rumble RB, Expert Panel on SLNB in Breast Cancer. Sentinel lymph node biopsy in early-stage breast cancer: guideline recommendations. Cancer Care Ontario (CCO). Evidence-based series No. 17–5: Section 1. [cited July 14, 2009]. http://www.cancercare.on.ca/common/pages/UserFile.aspx?fileId=45872. Accessed 24 Oct 2011.

  6. Kaufmann M, Morrow M, von Minckwitz G, Harris JR, Biedenkopf Expert Panel Members. Locoregional treatment of primary breast cancer: consensus recommendations from an international expert panel. Cancer. 2010;116:1184–91.

    PubMed  Article  Google Scholar 

  7. American Society of Breast Surgeons. Position Statement on Management of the Axilla in Patients with Invasive Breast Cancer. [cited August 31, 2011]. http://www.breastsurgeons.org/statements/PDF_Statements/Axillary_Management.pdf. Accessed 24 Oct 2011.

  8. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology—V.2.2011 [cited March 25, 2011]. http://www.nccn.org/professionals/physician_gls/PDF/breast.pdf. Accessed 24 Oct 2011.

  9. Krag DN, Weaver D, Ashikaga T, Moffat F, Klimberg VS, Chriver C, et al. The sentinel node in breast cancer—a multicenter validation study. N Engl J Med. 1998;339:941–6.

    PubMed  Article  CAS  Google Scholar 

  10. McMasters KM, Tuttle TM, Carlson DJ, Brown CM, Noyes RD, Glaser RL, et al. Sentinel lymph node biopsy for breast cancer: a suitable alternative to routine axillary dissection in multi-institutional practice when optimal technique is used. J Clin Oncol. 2000;18:2560–6.

    PubMed  CAS  Google Scholar 

  11. Martin RC, Edward MJ, Wong SL, Tuttle TM, Carlson DJ, Brown CM, et al. Practical guidelines for optimal gamma probe detection of sentinel lymph nodes in breast cancer: results of a multi-institutional study. Surgery. 2000;128:139–44.

    PubMed  Article  Google Scholar 

  12. Cody HS, Fey J, Akhurst T, Fazzari M, Mazumdar M, Yeung H, et al. Complementarity of blue dye and isotope in sentinel node localization for breast cancer: univariate and multivariate analysis of 966 procedures. Ann Surg Oncol. 2001;8:13–9.

    PubMed  Article  Google Scholar 

  13. Tafra L, Lannin DR, Swanson MS, Van Eyk JJ, Verbanac KM, Chua AN, et al. Multicenter trial of sentinel node biopsy for breast cancer using both technetium sulfur colloid and isosulfan blue dye. Ann Surg. 2001;233:51–9.

    PubMed  Article  CAS  Google Scholar 

  14. Krag DN, Anderson SJ, Julian TB, Brown AM, Harlow SP, Costantino JP, et al. Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial. Lancet Oncol. 2010;11(10):927–33.

    Google Scholar 

  15. Giuliano AE, Hunt KK, Ballman KV, Beitsch PD, Whitworth PW, Blumencranz PW, et al. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: A randomized controlled trial. JAMA. 2011;305:569–75.

    PubMed  Article  CAS  Google Scholar 

  16. Quan ML, McCready D. The evolution of lymph node assessment in breast cancer. J Surg Oncol. 2009;99:194–8.

    PubMed  Article  Google Scholar 

  17. Bergkvist L, Frisell J, Liljegren G, Celebroglu F, Damm S, Thorn M. Multicentre study of detection and false-negative rates in sentinel node biopsy for breast cancer. Br J Surg. 2001;88:1644–8.

    PubMed  Article  CAS  Google Scholar 

  18. Rivers A, Hansen N. Axillary management after sentinel lymph node biopsy in breast cancer patients. Surg Clin North Am. 2007;87:365–77.

    PubMed  Article  Google Scholar 

  19. Quan ML, Wells BJ, McCready DR, Wright FC, Fraser N, Gagliardi A. Beyond the false negative rate: development of quality indicators for sentinel lymph node biopsy in breast cancer. Ann Surg Oncol. 2010;17:579–91.

    PubMed  Article  Google Scholar 

  20. Wells BJ, Najjar H, Wright FC, Holloway CM, Fraser N, McCready D, et al. Measuring the quality of sentinel lymph node biopsy in breast cancer using newly developed quality indicators: a feasibility study. Ann Surg Oncol. 2011;18:78–85.

    PubMed  Article  Google Scholar 

  21. Lucci A, Kelemen PR, Miller C, III, Chardkoff L, Wilson L. National practice patterns of sentinel lymph node dissection for breast carcinoma. J Am Coll Surg. 2001;192:453–8.

    PubMed  Article  Google Scholar 

  22. Quan ML, Hodgson N, Lovrics P, Porter G, Poirier B, Wright FC. National adoption of sentinel node biopsy for breast cancer: lessons learned from the Canadian experience. Breast J. 2008;14:421–7.

    PubMed  Article  Google Scholar 

  23. AJCC Cancer Staging Manual. In: Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A, eds. AJCC Cancer Staging Manual. 7th ed. Chicago: Springer; 2010.

    Google Scholar 

  24. NHS Centre for Reviews and Dissemination (CRD). Systematic Review: CRDs Guidance for Undertaking Reviews in Health Care. York: University of York; 2009.

  25. Srigley JR, McGowan T, Maclean A, Raby M, Ross J, Kramer S, et al. Standardized synoptic cancer pathology reporting: a population-based approach. J Surg Oncol. 2009;99:517–24.

    PubMed  Article  Google Scholar 

  26. Caudle AS, Hunt KK, Kuerer HM, Meric-Bernstam F, Lucci A, Bedrosian I, et al. Multidisciplinary considerations in the implementation of the findings from the American College of Surgeons Oncology Group (ACOSOG) Z0011 study: a practice-changing trial. Ann Surg Oncol. 2011;18:2407–12.

    PubMed  Article  Google Scholar 

  27. Barry M, Kell MR. Breast cancer: can axillary lymph node dissection be avoided? Eur J Surg Oncol. 2012;38:6–7.

    PubMed  Article  CAS  Google Scholar 

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Acknowledgment

This study was funded by a grant from the Canadian Breast Cancer Foundation—Ontario Chapter.

Author information

Affiliations

  1. Department of Surgery, University of Toronto, Toronto, ON, Canada

    Bryan Wells MSc, MD

  2. Institute of Clinical and Evaluative Sciences, Toronto, ON, Canada

    Refik Saskin MSc

  3. Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Frances Wright MSc

  4. Department of Surgery, Princess Margaret Hospital, Toronto, ON, Canada

    David McCready MSc, MD

  5. Department of Surgery, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada

    May Lynn Quan MSc, MD

Authors
  1. Bryan Wells MSc, MD
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  2. Refik Saskin MSc
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  3. Frances Wright MSc
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  4. David McCready MSc, MD
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  5. May Lynn Quan MSc, MD
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Corresponding author

Correspondence to May Lynn Quan MSc, MD.

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Wells, B., Saskin, R., Wright, F. et al. Measuring the Quality of Sentinel Lymph Node Biopsy (SLNB) for Breast Cancer: A Population-Based Evaluation. Ann Surg Oncol 20, 615–619 (2013). https://doi.org/10.1245/s10434-012-2626-6

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  • DOI: https://doi.org/10.1245/s10434-012-2626-6

Keywords

  • Sentinel Lymph Node Biopsy
  • Axillary Lymph Node Dissection
  • Axillary Staging
  • Completion Axillary Lymph Node Dissection
  • Chart Abstraction