Patterns of axillary surgical care for breast cancer in the era of sentinel lymph node biopsy.
Ann Surg Oncol
; 16(3): 687-96, 2009 Mar.
Article
em En
| MEDLINE
| ID: mdl-19101768
ABSTRACT
BACKGROUND:
Population-based overall patterns of surgical management of the axilla in women with operable breast cancer during the era of adoption of sentinel lymph node biopsy (SLNB) were studied.METHODS:
Women with operable breast carcinoma residing in 14 geographic areas of the Surveillance, Epidemiology, and End Results (SEER) cancer registries (1998-2004, n=239,661) were assessed for axillary surgical patterns of care.RESULTS:
Use of SLNB increased from 11 to 59%. Use of no axillary surgery decreased from 14 to 6.6%. In pathologic node-negative women, use of axillary lymph node dissection (ALND) decreased from 94 to 36%. Independent factors most associated with failure to receive SLNB included diagnosis year (2000 62%; 2004 29%), surgery (mastectomy 64%; breast-conserving surgery 36%), tumor size (T3 71%; T2 56%; T1 40%), age (>or= 70 years 50%; <70 years 45%), grade (high 42%; low 38%), urbanity (non-large metropolitan area 49%; large metropolitan area 42%), and, by quartile, poverty (highest 47%; lowest 35%), and white-collar employment (lowest 56%; highest 47%). In pathologic node-positive women who had SLNB, failure to undergo completion ALND increased from 20% in 1998 to 32% in 2004. Patients with smaller, lower-grade tumors, and those with smaller size of nodal metastasis, lack of extracapsular extension, age >or= 70 years, increased linguistic isolation, African-American or Hispanic race/ethnicity, and white-collar employment were less likely to undergo completion ALND.CONCLUSIONS:
Management of the axilla changed dramatically during the period of rapid adoption of SLNB. Patterns of care suggest both appropriate and inappropriate selection for SLNB and ALND.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Neoplasias da Mama
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Carcinoma Medular
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Carcinoma Lobular
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Carcinoma Ductal de Mama
Tipo de estudo:
Etiology_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Aged
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Female
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Humans
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Middle aged
Idioma:
En
Ano de publicação:
2009
Tipo de documento:
Article