背景:目前的指南不建议对导管原位癌(DCIS)进行常规前哨淋巴结活检(SLNB),除了在乳房切除术或微创疾病的设置。这项研究旨在评估接受DCIS前期乳房切除术的女性的全国SLNB利用率,确定SLNB利用率的预测因子,并确定SLNB阳性的百分比。
方法:使用NCDB对2012年至2017年接受前期乳房切除术的临床DCIS女性进行了回顾性队列分析。比较了接受SLNB和未接受SLNB的患者的人口统计学和临床病理变量。使用多因素logistic回归模型来确定与SLNB利用和SLNB阳性相关的因素。
结果:约38,973例患者符合纳入标准:34,231例(88%)接受SLNB,4742例(12%)无手术腋窝分期。大多数患者年龄在50-69岁(51%),非西班牙裔白人(71%),私人保险(66%)。在多变量分析中,老年患者接受SLNB的可能性较小(P<0.01),而DCIS分级较高的患者更有可能接受SLNB(P<0.01)。在接受SLNB的患者中(n=34,231),只有1,149(3.4%)有淋巴结参与。非西班牙裔黑人患者SLNB阳性的几率增加(P<0.01),而那些患有雌激素受体阳性疾病的患者节点阳性的可能性较小(OR0.68,P<.001)。
结论:虽然88%的患者患有SLNB,只有3.4%的人发现节点阳性。鉴于如此低的利率,在选择低级别患者时考虑SLNB遗漏是合理的,接受前期乳房切除术的激素受体阳性DCIS。
BACKGROUND: Current guidelines do not recommend routine sentinel node biopsy (SLNB) for ductal carcinoma in situ (
DCIS), except in the setting of mastectomy or microinvasive disease. This study aimed to evaluate national SLNB utilization in women undergoing upfront mastectomy for
DCIS, identify predictors of SLNB utilization, and determine the percentage with a positive SLNB.
METHODS: A retrospective cohort analysis was performed using the NCDB of women with clinical
DCIS who underwent upfront mastectomy between 2012 and 2017. Demographic and clinicopathologic variables were compared between patients who underwent SLNB and those who did not. Multivariate logistic regression models were used to identify factors associated with SLNB utilization and positive SLNB.
RESULTS: About 38,973 patients met inclusion criteria: 34,231 (88%) underwent SLNB and 4742 (12%) had no surgical axillary staging. Most patients were age 50-69 (51%), non-Hispanic White (71%), with private insurance (66%). On multivariate analysis, older patients were less likely to receive SLNB (P < .01), while patients with higher grade
DCIS were more likely to undergo SLNB (P < .01). In those who underwent SLNB (n = 34,231), only 1,149 (3.4%) had nodal involvement. Non-Hispanic Black patients had increased odds of a positive SLNB (P < .01), while those with estrogen receptor positive disease were less likely to be node positive (OR 0.68, P < .001).
CONCLUSIONS: While 88% of patients had a SLNB, only 3.4% were found to be node positive. Given this low rate, it is reasonable to consider SLNB omission in select patients with low grade, hormone receptor positive
DCIS undergoing upfront mastectomy.