Initial axillary surgery: results from the BreastSurgANZ Quality Audit

Area of Science:

• Oncology
• Surgical Oncology
• Clinical Epidemiology

Background:

• Initial axillary surgery in invasive breast cancer management is critical.
• Practices varied regarding sentinel lymph node (SLN) biopsy versus axillary lymph node dissection (ALND).

Purpose of the Study:

• To determine trends and factors influencing initial axillary surgery choices.
• To analyze the adoption of SLN biopsy versus ALND in Australia and New Zealand.

Main Methods:

• Utilized data from the Breast Surgeon's Society of Australia and New Zealand Quality Audit (BQA) from 1999-2011.
• Analyzed patient data based on tumor size, age, insurance status, surgeon caseload, and hospital location.
• Examined the frequency of SLN biopsy, ALND, and no axillary surgery as initial procedures.

Main Results:

• A significant increase in SLN biopsy as initial surgery was observed from 1999-2011.
• Concomitant decline in the use of ALND as initial surgery occurred during the same period.
• Elderly women (>70) were less likely to undergo axillary surgery; larger tumors, older age, uninsured status, and regional surgery favored ALND over SLN biopsy.

Conclusions:

• Sentinel lymph node biopsy has become widely adopted as the initial axillary surgery for invasive breast cancer.
• Continued monitoring of these trends is recommended for future practice evaluation.