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Evolution in practice patterns of axillary management following mastectomy in patients with 1–2 positive sentinel nodes

  • Epidemiology
  • Published:
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Abstract

Purpose

The optimal management of breast cancer patients with a positive sentinel lymph node (SLN) who undergo mastectomy remains controversial. This study aimed to describe treatment patterns of patients with positive SLNs who undergo mastectomy using a large population-based database.

Methods

The NCDB was queried for cT1–2N0 breast cancer patients treated with mastectomy between 2006 and 2014 who had 1-2 positive SLNs. Patients receiving neoadjuvant chemotherapy were excluded. Axillary management included SLN dissection (SLND) alone, axillary lymph node dissection (ALND), post-mastectomy radiation (PMRT) alone, and ALND + PMRT. Trends of axillary management and patient characteristics were examined.

Results

Among 12,190 patients who met study criteria, the use of ALND dropped with a corresponding increase in other approaches. In 2006, 34% of patients had SLND alone, 47% ALND, 8% PMRT and 11% ALND + PMRT. By 2014, 37% had SLND, 23% ALND, 27% PMRT and 13% ALND + PMRT. Patients who underwent SLND alone were older (mean 60.6 years) with more comorbidities (Charlson–Deyo score > 2), smaller primary tumors (mean 2.1 cm), well-differentiated histology, hormone receptor-positive, HER2-negative tumors, without lymphovascular invasion (all P values < 0.01). Treatment with SLND alone was more likely if patients had only one positive SLN (P < 0.001) or micrometastatic disease (P < 0.001), and were treated at community centers compared with academic centers (P < 0.001).

Conclusions

The management of breast cancer patients undergoing mastectomy with positive SLNs has evolved over time with decreased use of ALND and increased use of radiation. Some patient subsets are underrepresented in recent clinical trials, and therefore, future trials should focus on these patients.

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Data Availability

The data that support the findings of this study are available from the National Cancer DataBase but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are, however, available from the authors upon reasonable request and with permission of the National Cancer DataBase.

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Acknowledgements

There was no specific funding or grant for this project. The Breast Surgical Oncology department of UT MD Anderson Cancer Center supported the work.

Author information

Author notes

  1. Anna Weiss & Elizabeth A. Mittendorf

    Present address: Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA

  2. Anna Weiss & Elizabeth A. Mittendorf

    Present address: Breast Oncology Program, Dana-Farber/Brigham and Women’s Cancer Center, Boston, MA, USA

  3. Gildy V. Babiera

    Present address: MD Anderson Physicians Network, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA

Authors and Affiliations

  1. Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1434, Houston, TX, 77030, USA

    Anna Weiss, Gildy V. Babiera, Isabelle Bedrosian, Henry M. Kuerer, Elizabeth A. Mittendorf, Abigail S. Caudle, Kelly K. Hunt & Rosa F. Hwang

  2. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Heather Lin & Yu Shen

  3. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Simona F. Shaitelman

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Correspondence to Rosa F. Hwang.

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Weiss, A., Lin, H., Babiera, G.V. et al. Evolution in practice patterns of axillary management following mastectomy in patients with 1–2 positive sentinel nodes. Breast Cancer Res Treat 176, 435–444 (2019). https://doi.org/10.1007/s10549-019-05243-7

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