Trends in Axillary Staging for Breast Cancer in the Elderly: Outcomes of Choosing Wisely at a High-Usage Institution

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery Pub Date : 2025-06-11 DOI:10.1016/j.amjsurg.2025.116477

Lena K. Egbert MD , Heidi Kosiorek MS , Patricia Cronin MD , Julie Billar MD , Richard Bold MD, MBA , Barbara Pockaj MD

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Abstract

Background

In 2016, a Choosing Wisely guideline was published recommending omission of sentinel lymph node biopsy (SLNB) in low-risk elderly females with breast cancer. Our study evaluated trends and factors associated with omission of axillary surgery.

Methods

Patients ≥70 years old undergoing surgery for an initial diagnosis of invasive breast cancer from 2014 to 2022 at our institution were retrospectively reviewed. A sub-group of pT1, cN0, ER+/HER2-patients was analyzed.

Results

A total of 218 pT1, cN0, ER+/HER2-patients were identified. In these patients, the percentage of SLNB performed decreased from 73 % in 2014 to 30 % in 2022 (p < 0.0001). Older age (OR 0.82, 95 % CI 0.73–0.91) and smaller preoperative tumor size (OR 3.63, 95 % CI 1.62–8.14) were associated with SLNB omission. There were no differences in loco-regional recurrence-free survival (p = 0.57) and disease-free survival (p = 0.66) with SLNB omission.

Conclusions

With increasing omission of axillary staging, there was no adverse impact on recurrence-free survival.

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老年乳腺癌腋窝分期趋势：在高使用率机构中明智选择的结果

2016年，《明智选择指南》（Choosing Wisely guide）发布，建议对低风险老年女性乳腺癌患者省略前哨淋巴结活检（SLNB）。我们的研究评估了遗漏腋窝手术的趋势和相关因素。方法回顾性分析2014年至2022年在我院接受初步诊断为浸润性乳腺癌手术的≥70岁患者。对pT1、cN0、ER+/ her2患者进行亚组分析。结果共检出pT1、cN0、ER+/ her2患者218例。在这些患者中，SLNB的实施比例从2014年的73%下降到2022年的30% (p <；0.0001)。年龄较大（OR 0.82, 95% CI 0.73-0.91）和术前肿瘤大小较小（OR 3.63, 95% CI 1.62-8.14）与SLNB遗漏相关。遗漏SLNB的局部-区域无复发生存率（p = 0.57）和无病生存率（p = 0.66）无差异。结论随着腋窝分期的增加，对无复发生存无不利影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American journal of surgery 医学-外科

CiteScore

5.00

自引率

6.70%

发文量

570

审稿时长

56 days

期刊介绍： The American Journal of Surgery® is a peer-reviewed journal designed for the general surgeon who performs abdominal, cancer, vascular, head and neck, breast, colorectal, and other forms of surgery. AJS is the official journal of 7 major surgical societies* and publishes their official papers as well as independently submitted clinical studies, editorials, reviews, brief reports, correspondence and book reviews.