ALND Experience During Breast Surgical Oncology Fellowship over the Years: An SSO/ASBrS Collaborative Analysis

Given clinical practice trends of de-escalation of axillary surgery, we hypothesize a decrease axillary lymph node dissection (ALND) experience during breast surgical oncology (BSO) training. We evaluate BSO fellow ALND experience overtime.

With institutional and society approval (Society of Surgical Oncology, SSO; American Society of Breast Surgeons, ASBrS), de-identified case log data were reviewed. Fellows were classified based on graduation year (GY). Number of procedures are reported as the mean with standard deviation (SD). Trends in procedures performed over time were evaluated with both univariate and multivariable linear regression models which adjusted for program size, geographic region and logging fatigue.

Case log data from 645 fellows across 63 programs (GY 2016-2024) was analyzed. Overall mean number of ALNDs was 23.1 (SD 11.1) and decreased over time (estimate -0.64; p<0.001) with a mean of 23.2 (13.0) per fellow graduating in 2016 versus 19.0 (7.0) per fellow in 2024. Decrease in ALND remained significant after adjusting for size of fellowship program and geographic region (estimate -0.60, p<0.001) as well as for logging fatigue (estimate -0.52; p=0.002).

The number of ALNDs performed during SSO/ASBrS BSO fellowship has decreased in more recent years; however, the case minimums are still consistently met. Understanding the current state of training is paramount to ensure fellows are appropriately trained as locoregional de-escalation trends continue.