| Title |
A Population-Based Study of the Effects of a Regional Guideline for Completion Axillary Lymph Node Dissection on Axillary Surgery in Patients with Breast Cancer
|
|---|---|
| Published in |
Annals of Surgical Oncology, June 2016
|
| DOI | 10.1245/s10434-016-5310-4 |
| Pubmed ID | |
| Authors |
Miriam W. Tsao, Sylvie D. Cornacchi, Nicole Hodgson, Marko Simunovic, Lehana Thabane, Ji Cheng, Mary Ann O’Brien, Barbara Strang, Som D. Mukherjee, Peter J. Lovrics |
| Abstract |
Evidence from the American College of Surgeons Oncology Group (ACOSOG) Z0011 trial suggests completion axillary lymph node dissection (cALND) after positive sentinel lymph node biopsy (+SLNB) does not improve outcomes in select patients, leading to practice variation. A multidisciplinary group of surgeons, oncologists, and pathologists developed a regional guideline for cALND which was disseminated in August 2012. We assessed the impact of Z0011 and the regional guideline on cALND rates. Consecutive invasive breast cancer cases undergoing SLNB were reviewed at 12 hospitals. Patient, tumor, and process measures were collected for three time periods: TP1, before publication of Z0011 (May 2009-August 2010); TP2, after publication of Z0011 (March 2011-June 2012); and TP3, after guideline dissemination (January 2013-April 2014). Cases were categorized by whether they met the guideline criteria for cALND (i.e. ≤50 years, mastectomy, T3 tumor, three or more positive sentinel lymph nodes [SLNs]) or not (e.g. age > 50 years, breast-conserving surgery, T1/T2 tumor, and one to two positive SLNs). The SLNB rate increased from 56 % (n = 620), to 70 % (n = 774), to 78 % (n = 844) in TP1, TP2, and TP3, respectively. Among cases not recommended for cALND using the guideline criteria, cALND rates decreased significantly over time (TP1, 71 %; TP2, 43 %; TP3, 17 %) [p < 0.001]. The cALND rate also decreased over time among cases recommended to have cALND using the guideline criteria (TP1, 92 %; TP2, 69 %; TP3, 58 %) [p < 0.001]. Based on multivariable analysis, age and nodal factors appeared to be significant factors for cALND decision making. Publication of ACOSOG Z0011 and regional guideline dissemination were associated with a marked decrease in cALND after +SLNB, even among several cases in which the guideline recommended cALND. |
X Demographics
The data shown below were collected from the profile of 1 X user who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 1 | 100% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 1 | 100% |
Mendeley readers
The data shown below were compiled from readership statistics for 36 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Canada | 1 | 3% |
| Unknown | 35 | 97% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Researcher | 6 | 17% |
| Student > Master | 5 | 14% |
| Student > Postgraduate | 4 | 11% |
| Other | 3 | 8% |
| Student > Bachelor | 3 | 8% |
| Other | 6 | 17% |
| Unknown | 9 | 25% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 15 | 42% |
| Nursing and Health Professions | 3 | 8% |
| Biochemistry, Genetics and Molecular Biology | 1 | 3% |
| Business, Management and Accounting | 1 | 3% |
| Pharmacology, Toxicology and Pharmaceutical Science | 1 | 3% |
| Other | 4 | 11% |
| Unknown | 11 | 31% |
Attention Score in Context
This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 28 June 2016.
All research outputs
#18,464,797
of 22,879,161 outputs
Outputs from Annals of Surgical Oncology
#4,999
of 6,486 outputs
Outputs of similar age
#267,641
of 352,727 outputs
Outputs of similar age from Annals of Surgical Oncology
#132
of 178 outputs
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