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Trends in Sentinel Lymph Node Biopsies in Patients With Inflammatory Breast Cancer in the US

IMPORTANCE: The standard of care for inflammatory breast cancer (IBC) is neoadjuvant chemotherapy, total mastectomy with axillary lymph node dissection (ALND), and postmastectomy radiation therapy. Existing studies suggest that sentinel lymph node biopsy (SLNB) may not be reliable in IBC. The use an...

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Autores principales: Sosa, Alan, Lei, Xiudong, Woodward, Wendy A., Chavez Mac Gregor, Mariana, Lucci, Anthony, Giordano, Sharon H., Nead, Kevin T.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8837909/
https://www.ncbi.nlm.nih.gov/pubmed/35147686
http://dx.doi.org/10.1001/jamanetworkopen.2021.48021
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author Sosa, Alan
Lei, Xiudong
Woodward, Wendy A.
Chavez Mac Gregor, Mariana
Lucci, Anthony
Giordano, Sharon H.
Nead, Kevin T.
author_facet Sosa, Alan
Lei, Xiudong
Woodward, Wendy A.
Chavez Mac Gregor, Mariana
Lucci, Anthony
Giordano, Sharon H.
Nead, Kevin T.
author_sort Sosa, Alan
collection PubMed
description IMPORTANCE: The standard of care for inflammatory breast cancer (IBC) is neoadjuvant chemotherapy, total mastectomy with axillary lymph node dissection (ALND), and postmastectomy radiation therapy. Existing studies suggest that sentinel lymph node biopsy (SLNB) may not be reliable in IBC. The use and frequency of SLNB in women with IBC is not well characterized. OBJECTIVE: To determine the frequency and temporal trend of SLNB in patients with IBC. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used the National Cancer Database, a nationwide hospital-based cancer registry, and included women who were diagnosed with nonmetastatic IBC and underwent axillary surgery from 2012 to 2017. Data were analyzed from January 2021 to May 2021. EXPOSURES: Any SLNB, including SLNB alone and SLNB followed by ALND, and ALND alone. MAIN OUTCOMES AND MEASURES: Scatterplot fit with a linear regression model were used to evaluate the yearly increase of any SLNB use. Multivariable logistic regression models to evaluate the association of study variables with the outcome of any SLNB. RESULTS: This study included a total of 1096 women (mean [SD] age, 56.1 [12.9] years) who were 18 years or older with nonmetastatic IBC diagnosed between 2012 and 2017. Of the 186 of 1096 women (17%) who received any SLNB, 137 (73.7%) were White individuals; and of the 910 of 1096 women (83%) who received an ALND only, 676 (74.3%) were White individuals. Among women undergoing any SLNB, 119 of 186 (64%) did not undergo a completion ALND. There was a statistically significant increasing trend in the use of SLNB from 2012 to 2017 (22 of 205 patients [11%] vs 32 of 148 patients [22%]; P = .004). In multivariable analysis, the use of SLNB was associated with diagnosis year (2017 vs 2012; odds ratio [OR], 2.26; 95% CI, 1.26-4.20), clinical nodal status (cN3 vs 0; OR, 0.39; 95% CI, 0.22-0.67), and receipt of reconstructive surgery (OR, 1.80; 95% CI, 1.09-2.96). CONCLUSIONS AND RELEVANCE: The findings of this cohort study suggest that there is frequent and increasing use of SLNB in patients with IBC that is not evidence-based or supported by current treatment guidelines.
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spelling pubmed-88379092022-02-18 Trends in Sentinel Lymph Node Biopsies in Patients With Inflammatory Breast Cancer in the US Sosa, Alan Lei, Xiudong Woodward, Wendy A. Chavez Mac Gregor, Mariana Lucci, Anthony Giordano, Sharon H. Nead, Kevin T. JAMA Netw Open Original Investigation IMPORTANCE: The standard of care for inflammatory breast cancer (IBC) is neoadjuvant chemotherapy, total mastectomy with axillary lymph node dissection (ALND), and postmastectomy radiation therapy. Existing studies suggest that sentinel lymph node biopsy (SLNB) may not be reliable in IBC. The use and frequency of SLNB in women with IBC is not well characterized. OBJECTIVE: To determine the frequency and temporal trend of SLNB in patients with IBC. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used the National Cancer Database, a nationwide hospital-based cancer registry, and included women who were diagnosed with nonmetastatic IBC and underwent axillary surgery from 2012 to 2017. Data were analyzed from January 2021 to May 2021. EXPOSURES: Any SLNB, including SLNB alone and SLNB followed by ALND, and ALND alone. MAIN OUTCOMES AND MEASURES: Scatterplot fit with a linear regression model were used to evaluate the yearly increase of any SLNB use. Multivariable logistic regression models to evaluate the association of study variables with the outcome of any SLNB. RESULTS: This study included a total of 1096 women (mean [SD] age, 56.1 [12.9] years) who were 18 years or older with nonmetastatic IBC diagnosed between 2012 and 2017. Of the 186 of 1096 women (17%) who received any SLNB, 137 (73.7%) were White individuals; and of the 910 of 1096 women (83%) who received an ALND only, 676 (74.3%) were White individuals. Among women undergoing any SLNB, 119 of 186 (64%) did not undergo a completion ALND. There was a statistically significant increasing trend in the use of SLNB from 2012 to 2017 (22 of 205 patients [11%] vs 32 of 148 patients [22%]; P = .004). In multivariable analysis, the use of SLNB was associated with diagnosis year (2017 vs 2012; odds ratio [OR], 2.26; 95% CI, 1.26-4.20), clinical nodal status (cN3 vs 0; OR, 0.39; 95% CI, 0.22-0.67), and receipt of reconstructive surgery (OR, 1.80; 95% CI, 1.09-2.96). CONCLUSIONS AND RELEVANCE: The findings of this cohort study suggest that there is frequent and increasing use of SLNB in patients with IBC that is not evidence-based or supported by current treatment guidelines. American Medical Association 2022-02-11 /pmc/articles/PMC8837909/ /pubmed/35147686 http://dx.doi.org/10.1001/jamanetworkopen.2021.48021 Text en Copyright 2022 Sosa A et al. JAMA Network Open. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the CC-BY License.
spellingShingle Original Investigation
Sosa, Alan
Lei, Xiudong
Woodward, Wendy A.
Chavez Mac Gregor, Mariana
Lucci, Anthony
Giordano, Sharon H.
Nead, Kevin T.
Trends in Sentinel Lymph Node Biopsies in Patients With Inflammatory Breast Cancer in the US
title Trends in Sentinel Lymph Node Biopsies in Patients With Inflammatory Breast Cancer in the US
title_full Trends in Sentinel Lymph Node Biopsies in Patients With Inflammatory Breast Cancer in the US
title_fullStr Trends in Sentinel Lymph Node Biopsies in Patients With Inflammatory Breast Cancer in the US
title_full_unstemmed Trends in Sentinel Lymph Node Biopsies in Patients With Inflammatory Breast Cancer in the US
title_short Trends in Sentinel Lymph Node Biopsies in Patients With Inflammatory Breast Cancer in the US
title_sort trends in sentinel lymph node biopsies in patients with inflammatory breast cancer in the us
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8837909/
https://www.ncbi.nlm.nih.gov/pubmed/35147686
http://dx.doi.org/10.1001/jamanetworkopen.2021.48021
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