Blue CM, Ong C, Khan J, Deng X, Bandyopadhyay D, Louie RJ, McGuire KP. Concordant care in sentinel lymph node omission following Choosing Wisely® recommendations at a comprehensive cancer center.
Am J Surg 2024;
227:183-188. [PMID:
37821293 DOI:
10.1016/j.amjsurg.2023.10.017]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/27/2023] [Accepted: 10/02/2023] [Indexed: 10/13/2023]
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.
Collapse