Sentinel lymph node biopsy in breast cancer: Canadian practice patterns

Area of Science:

• Oncology
• Surgical Practice
• Clinical Research

Background:

• Sentinel lymph node biopsy (SLNBx) for invasive breast cancer (IBC) is increasingly utilized in the US, often outside clinical trials.
• Practice patterns and criteria for discontinuing concurrent axillary lymph node dissection for IBC in Canada are not well-defined.

Purpose of the Study:

• To describe the current practice patterns of SLNBx for IBC in Canada.
• To identify criteria influencing the decision to abandon routine axillary lymph node dissection concurrently with SLNBx.

Main Methods:

• A 31-item questionnaire was distributed to 1172 active general surgeons across Canada.
• Data from 519 respondents treating IBC were analyzed to assess SLNBx adoption and reasons for non-use.

Main Results:

• Only 27% of responding surgeons performed SLNBx for IBC; 73% did not, primarily citing a lack of resources (64%).
• Of those performing SLNBx, 16% were enrolled in clinical trials. Surgeons abandoning routine axillary lymph node dissection often did so after fewer than 30 combined procedures.
• Multivariate analysis indicated that surgical oncology fellowship training, a higher proportion of breast disease practice, and more operating room days per week were associated with SLNBx use.

Conclusions:

• SLNBx for IBC in Canada is less prevalent compared to the US, with minimal participation in clinical trials.
• Fellowship-trained surgical oncologists and surgeons with extensive breast disease experience are key drivers in the adoption of SLNBx for IBC.