Journal: Annals of surgical oncology
Study focus
- The study evaluated how often US hospitals omit sentinel lymph node biopsy (SNB) in women ≥70 years with cT1N0, hormone receptor–positive, HER2‑negative invasive breast cancer undergoing breast-conserving surgery—a practice now recommended by the Commission on Cancer as a quality measure.
Data and methods
- Data source: National Cancer Data Base (2012–2023).
- Population: 185,859 women meeting the above criteria.
- Outcomes:
- Trends in SNB omission over time.
- Facility-level estimated performance rates (EPR: proportion of eligible patients not receiving SNB).
- Facility characteristics associated with achieving at least the median omission rate (25% EPR) via multivariable analysis.
Key results
- Overall omission: SNB was omitted in 23.4% (43,513/185,859) of eligible patients.
- Time trend: Omission increased from 14% in 2012 to 44% in 2023 but still remained under half of eligible cases in 2023.
- Facility performance (2021–2023):
- 30% EPR achieved by 52.9% of facilities.
- 40% EPR achieved by 41.9% of facilities.
- 50% EPR achieved by 31.7% of facilities.
- 60% EPR achieved by 22.5% of facilities.
- 70% EPR achieved by 12.5% of facilities.
- 80% EPR achieved by only 6.9% of facilities.
- Facilities more likely to reach at least the median 25% EPR (on multivariate analysis):
- >50% of patients privately insured (OR 1.7, 95% CI 1.23–2.34).
- Academic/teaching centers (OR 2.12, 95% CI 1.36–3.3).
- High-volume centers (>250 annual cases; OR 2.07, 95% CI 1.35–3.18).
- Certain US census regions were also associated with higher omission, though specific regions are not detailed in the abstract.
- All listed associations were statistically significant (p < 0.05).
Conclusion and implication
- By 2023, fewer than half of eligible older women had SNB omitted, despite evidence supporting omission in this group.
- There is substantial variability across facilities, with higher omission rates in academic, high-volume, and more privately insured centers.
- These data highlight a significant, system-level opportunity to improve adherence to this de-escalation quality measure in early-stage HR+/HER2‑negative breast cancer in older patients.