Concordant care in sentinel lymph node omission following Choosing Wisely® recommendations at a comprehensive cancer center

Christian M Blue; Cynthia Ong; Jamal Khan; Xiaoyan Deng; Dipankar Bandyopadhyay; Raphael J Louie; Kandace P McGuire

doi:10.1016/j.amjsurg.2023.10.017

Concordant care in sentinel lymph node omission following Choosing Wisely® recommendations at a comprehensive cancer center

Am J Surg. 2024 Jan:227:183-188. doi: 10.1016/j.amjsurg.2023.10.017. Epub 2023 Oct 5.

Authors

Christian M Blue¹, Cynthia Ong², Jamal Khan², Xiaoyan Deng³, Dipankar Bandyopadhyay³, Raphael J Louie⁴, Kandace P McGuire⁵

Affiliations

¹ Virginia Commonwealth University, School of Medicine, 1201 E Marshall St #4-100, Richmond, VA, 23298, USA. Electronic address: bluecm@vcu.edu.
² Virginia Commonwealth University, School of Medicine, 1201 E Marshall St #4-100, Richmond, VA, 23298, USA.
³ Virginia Commonwealth University, Department of Biostatistics, 830 E Main Street, One Capitol Square 734, PO Box 980032, Richmond, VA, 23219, USA.
⁴ Virginia Commonwealth University, Department of Surgery, 1200 E Broad St PO Box 980645 Richmond, VA, 23298, USA.
⁵ Virginia Commonwealth University, Department of Surgery, 1200 E Broad St PO Box 980645 Richmond, VA, 23298, USA. Electronic address: kandace.mcguire@vcuhealth.org.

PMID: 37821293
DOI: 10.1016/j.amjsurg.2023.10.017

Abstract

Background: In 2016, the SSO and ABIM released a Choosing Wisely® guideline stating SLNB can be safely omitted in women ≥70 with HR + HER-invasive breast cancer. No study evaluating concordance of care with this guideline has been performed within a comprehensive cancer center.

Methods: From 2005 to 2020, there were 382 patients with cT1-2N0 invasive carcinoma ER+/PR+ and HER2-identified as having undergone SLNB. These patients were then separated into two groups; those in the pre-guideline concordance cohort (2005-2015) and those in the post-guideline concordance (2016-2020) cohort. Axillary management concordance was trended over time.

Results: 382 patients from 2005 to 2020 with HR + HER- IBC were identified. No difference was seen in SLNB pre-versus post-guidelines (p = 0.35). Increased concordance was noted as age increased (p = 0.0068) and adjuvant radiation therapy exclusion (p < 0.0001) post-guideline release. Concordance improved over the years post-guideline release (R² = 0.45).

Conclusions: Surgical guideline adoption occurs over time but may also be affected by outside decisions and factors. Further study into patterns of guideline adoption may facilitate improving adherence to guidelines.

Keywords: Breast cancer; Choosing wisely guideline; Elderly population; Guideline concordance; Sentinel lymph node biopsy; Trends over time.

MeSH terms

Axilla / pathology
Breast Neoplasms* / pathology
Female
Humans
Lymph Node Excision
Lymph Nodes / pathology
Neoplasm Staging
Sentinel Lymph Node Biopsy
Sentinel Lymph Node* / pathology