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National Variation in Implementation of Sentinel Lymph Node Biopsy for Clinically Node-Positive Patients Undergoing
Crystal D Taylor1,2,3,4, Ton Wang5, Brandy R Sinco2
1Department of Surgery, Michigan Medicine, Ann Arbor, MI, USA.
Annals of Surgical Oncology
|April 18, 2025
Summary
Axillary surgery is de-escalating in breast cancer patients after neoadjuvant chemotherapy. However, the rate of removing three or more sentinel lymph nodes (SLNs) remains unchanged, with significant variation between facilities.
Area of Science:
- Oncology
- Surgical Oncology
- Breast Cancer Research
Background:
- Sentinel lymph node biopsy (SLNB) is a key procedure for clinically node-positive breast cancer patients post-neoadjuvant chemotherapy.
- Achieving low false-negative rates in SLNB relies on technical factors, like removing at least three sentinel lymph nodes (SLNs).
- The consistency of adherence to the "three or more SLNs" guideline is not well-understood.
Purpose of the Study:
- To analyze trends in axillary surgery for breast cancer patients with clinical node-positive disease (cN1-cN2) who underwent neoadjuvant chemotherapy.
- To assess adherence to the guideline of removing three or more SLNs during SLNB.
- To evaluate variations in SLN yield across different healthcare facilities.
Main Methods:
- A retrospective cohort study was conducted using the National Cancer Database (2012-2020).
- Included were women aged 18+ with cN1-cN2 breast cancer who received neoadjuvant chemotherapy.
- Analysis focused on trends in axillary surgery procedures and SLN yield.
Main Results:
- The study included 67,365 women; the median age was 54 years.
- SLNB alone increased from 14% to 39%, SLNB with completion axillary lymph node dissection (ALND) rose from 17% to 30%, while ALND alone decreased from 69% to 27%.
- The rate of obtaining three or more SLNs remained stable at 66%, but facility-level adherence varied widely (40%-86%).
Conclusions:
- Axillary surgery is de-escalating, with reduced use of completion ALND after neoadjuvant chemotherapy.
- Despite de-escalation, the rate of achieving the "three or more SLNs" benchmark has not improved.
- Significant variation exists in SLN yield among facilities, highlighting a need for standardized techniques.
