Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Jan;119(1):101-108.
doi: 10.1002/jso.25294. Epub 2018 Nov 27.

Assessment of hospital-level adjusted breast cancer sentinel lymph node positivity rates

Elizabeth R Berger  1   2 , Karl Y Bilimoria  3   4   5 , Christine V Kinnier  4   6 , Christina A Minami  4   5 , Kevin P Bethke  5 , Nora M Hansen  5 , Ryan P Merkow  4   5   6 , David P Winchester  7 , Anthony D Yang  3   4   5
Affiliations

Assessment of hospital-level adjusted breast cancer sentinel lymph node positivity rates

Elizabeth R Berger et al. J Surg Oncol. 2019 Jan.

Abstract

Background/objectives: Proficiency of performing sentinel lymph node biopsy (SLNB) for breast cancer varies among hospitals and may be reflected in the hospital's SLNB positivity rate. Our objectives were to examine whether hospital characteristics are associated with variation in SLNB positivity rates and whether hospitals with lower-than-expected SLNB positivity rates have worse patient survival.

Methods: Using the National Cancer Data Base, stage I to III breast cancer patients were identified (2004-2012). Hospital-level SLNB positivity rates were adjusted for tumor and patient factors. Hospitals were divided into terciles of SLNB positivity rates (lower-, higher-, as-expected). Hospital characteristics and survival were examined across terciles.

Results: Of 438 610 SLNB patients (from 1357 hospitals), 78 104 had one or more positive SLN (21.3%). Hospitals in the low and high terciles were more likely to be low volume (low: RRR, 4.40; 95% CI, 2.89-6.57; P < 0.001; and high: RRR, 1.79; 95% CI, 1.21-2.64; P < 0.001) compared to hospitals with as-expected (middle tercile) SLNB positivity rates. Stage I patients at low- and high-tercile hospitals had statistically worse survival.

Conclusions: There is a wide variation in hospital SLNB positivity rates. Hospitals with lower- or higher-than-expected SLNB positivity rates were associated with survival differences. Hospital SLNB positivity rates may be a novel 'process measure' to report to hospitals for internal quality assessment.

Keywords: breast cancer; health outcomes; node biopsy; process measures; quality metric; sentinel lymph.

PubMed Disclaimer

Similar articles

See all similar articles

References

    1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin. 2016;66(1):7–30. - PubMed
    1. Cox CE, Pendas S, Cox JM, et al. Guidelines for sentinel node biopsy and lymphatic mapping of patients with breast cancer. Ann Surg. 1998;227(5):645–651. - PMC - PubMed
    1. Morton DL. Intraoperative lymphatic mapping and sentinel lymphadenectomy: community standard care or clinical investigation? Cancer J Sci Am. 1997;3(6):328–330. - PubMed
    1. Orr RK, Hoehn JL, Col NF. The learning curve for sentinel node biopsy in breast cancer: practical considerations. Arch Surg. 1999;134(7):764–767. - PubMed
    1. Veenstra HJ, Wouters MJWM, Kroon BBR, Olmos RAV, Nieweg OE. Less false-negative sentinel node procedures in melanoma patients with experience and proper collaboration. J Surg Oncol. 2011;104(5):454–457. - PubMed