Factors associated with lymph node assessment in ductal carcinoma in situ: analysis of 1988-2002 seer data

Matthew R Porembka; Rebecca L Abraham; Julianne A Sefko; Anjali D Deshpande; Donna B Jeffe; Julie A Margenthaler

doi:10.1245/s10434-008-9947-5

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Factors associated with lymph node assessment in ductal carcinoma in situ: analysis of 1988-2002 seer data

Journal article

Peer reviewed

Factors associated with lymph node assessment in ductal carcinoma in situ: analysis of 1988-2002 seer data

Matthew R Porembka, Rebecca L Abraham, Julianne A Sefko, Anjali D Deshpande, Donna B Jeffe and Julie A Margenthaler

Annals of surgical oncology, Vol.15(10), pp.2709-2719

10/2008

DOI: 10.1245/s10434-008-9947-5

PMID: 18483831

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Abstract

Ductal carcinoma in situ (DCIS) represents 20-30% of mammographically detected breast cancers, but the role of lymph node assessment (LNA) in women with DCIS remains unclear. Using the 1988-2002 Surveillance, Epidemiology, and End Results (SEER) Program data, we conducted a case-control study to identify variables associated with (1) LNA in DCIS patients and (2) use of axillary lymph node dissection (ALND) compared with sentinel lymph node biopsy (SLNB). Using separate multivariable logistic regression models, we identified patient and tumor-related factors associated with LNA (1988-2002) and with the method used (recorded only in 1998-2002). We report adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Of 23,502 women with DCIS, 37% underwent mastectomy and 63% underwent breast-conservation therapy (BCT); 6,650 cases (28%) underwent LNA. Women younger than 80 years (aOR 1.47; 95% CI 1.24-1.75) or who had mastectomy (aOR 11.06; 95% CI 10.30-11.90), tumor size greater than 9 mm (aORs ranged from 1.27-1.97 for 10-mm increments from 10 to 50 mm or more) or poorly differentiated grade (aOR 1.33; 95% CI 1.11-1.55) were more likely to have had a LNA. From 1998 to 2002, 10,637 women underwent resection for DCIS (21% mastectomy; 79% BCT); of these, 2,219 (21%) had LNA (73% mastectomy; 27% BCT). Mastectomy patients were 3.52 times more likely to receive ALND (95% CI 2.71-4.57) than SLNB, after controlling for other factors. Optimal guidelines for use of LNA in DCIS have not been defined. However, there appeared to be a persistent and excessive utilization of ALND for LNA in women with DCIS (1998-2002).

Lymph Node Excision

Breast Neoplasms - surgery

SEER Program

Lymph Nodes - pathology

Prognosis

Neoplasm Invasiveness

Humans

Lymphatic Metastasis

Case-Control Studies

Time Factors

Breast Neoplasms - pathology

Aged, 80 and over

Mastectomy

Adult

Female

Aged

Sentinel Lymph Node Biopsy

Odds Ratio

Carcinoma, Intraductal, Noninfiltrating - secondary

Details

Title: Subtitle: Factors associated with lymph node assessment in ductal carcinoma in situ: analysis of 1988-2002 seer data
Creators: Matthew R Porembka - Department of Surgery, Washington University School of Medicine, St. Louis, MO, 63110, USA
Rebecca L Abraham - Saint Louis University
Julianne A Sefko
Anjali D Deshpande
Donna B Jeffe
Julie A Margenthaler
Resource Type: Journal article
Publication Details: Annals of surgical oncology, Vol.15(10), pp.2709-2719
Publisher: United States
DOI: 10.1245/s10434-008-9947-5
PMID: 18483831
ISSN: 1068-9265
eISSN: 1534-4681
Language: English
Date published: 10/2008
Academic Unit: Epidemiology
Record Identifier: 9983996086702771

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