TY  - JOUR
T1  - UNderuse of axillary dissection for the management of sentinel node micrometastases in breast cancer
AU  - Wasif N, Maggard MA, Ko CY, Giuliano AE
Y1  - 2010/02/01
N1  - 10.1001/archsurg.2009.269
JO  - Archives of Surgery
SP  - 161
EP  - 166
VL  - 145
IS  - 2
N2  - Background 
    Current American Society of Clinical Oncology guidelines for management of sentinel node micrometastases (SNMM) in breast cancer recommend axillary lymph node dissection (ALND) for all patients.Objective 
    To assess nationwide use of ALND for SNMM.Design 
    Population-based retrospective observational study.Setting 
    The National Cancer Institute's Surveillance, Epidemiology, and End Results database (1998-2005).Patients 
    Five thousand three hundred fifty-three patients with SNMM.Main Outcome Measure 
    Use of ALND after identification of SNMM.Results 
    The prevalence of SNMM increased from 2.5% in 1998 to 17.7% in 2005. Of 5353 patients with SNMM, 2160 (40.4%) had no further nodal surgery and 3193 (59.6%) underwent ALND. In the latter group, histopathologic examination of nonsentinel nodes upstaged 18.6% of cases to N1, 2.2% to N2, and 0.1% to N3 disease. Multivariate analysis using logistic regression showed that age younger than 66 years (odds ratio [OR], 1.79; 95% confidence interval [CI], 1.56-2.04), high tumor grade (OR, 1.22; 95% CI, 1.07- 1.40), and tumor size larger than 2 cm (OR, 1.16; 95% CI, 1.01-1.32) were predictive of ALND. Predictors of upstaging were infiltrating lobular histology (OR, 1.23; 95% CI, 1.00-1.51), T2 stage (OR, 1.38; 95% CI, 1.14-1.67), T3 stage (OR, 3.66; 95% CI, 1.70-7.90), and number of nodes examined (OR, 1.04; 95% CI, 1.03-1.05).Conclusions 
    Only 60% of patients with SNMM from breast cancer are treated according to American Society of Clinical Oncology guidelines. Nodal staging based only on sentinel node biopsy may underestimate the extent of nodal disease in 20.9% of cases. Surgical management of SNMM should be standardized.
SN  - 0004-0010
M3  - doi: 10.1001/archsurg.2009.269
UR  - http://dx.doi.org/10.1001/archsurg.2009.269
ER  -