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Ann Surg Oncol. 2018 Jun;25(6):1521-1529. doi: 10.1245/s10434-018-6410-0. Epub 2018 Mar 7.

Associations Between Sentinel Lymph Node Biopsy and Complications for Patients with Ductal Carcinoma In Situ.

Author information

1
Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale University School of Medicine, New Haven, CT, USA.
2
Department of Surgery, Yale University School of Medicine, New Haven, CT, USA.
3
Department of Chronic Disease Epidemiology, Yale University School of Public Health, 60 College Street, New Haven, CT, 06520, USA.
4
Section of Medical Oncology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
5
Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA.
6
Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
7
Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale University School of Medicine, New Haven, CT, USA. shiyi.wang@yale.edu.
8
Department of Chronic Disease Epidemiology, Yale University School of Public Health, 60 College Street, New Haven, CT, 06520, USA. shiyi.wang@yale.edu.

Abstract

PURPOSE:

To examine the associations between sentinel lymph node biopsy (SLNB) and complications among older patients who underwent breast-conserving surgery (BCS) for ductal carcinoma in situ (DCIS).

METHODS:

We identified women from the Surveillance, Epidemiology, and End Results-Medicare dataset aged 67-94 years diagnosed during 1998-2011 with DCIS who underwent BCS as initial treatment. We assessed incidence of complications, including lymphedema, wound infection, seroma, or pain, within 9 months of diagnosis. We used Mahalanobis matching and generalized linear models to estimate the associations between SLNB and complications.

RESULTS:

Our sample consisted of 15,515 beneficiaries, 2409 (15.5%) of whom received SLNB. Overall, 16.8% of women who received SLNB had complications, compared with 11.3% of women who did not receive SLNB (p < 0.001). Use of SLNB was associated with subsequent mastectomy but not radiotherapy. Multivariate analyses of the matched sample showed that, compared with no SLNB, SLNB use was significantly associated with incidence of any complication [adjusted odds ratio (AOR) 1.39; 99% confidence interval (CI) 1.18-1.63], lymphedema (AOR 4.45; 99% CI 2.27-8.75), wound infection (AOR 1.24; 99% CI 1.00-1.54), seroma (AOR 1.40; 99% CI 1.03-1.91), and pain (AOR 1.31; 99% CI 1.04-1.65). Sensitivity analyses excluding patients who underwent mastectomy yielded qualitatively similar results regarding the associations between SLNB and complications.

CONCLUSIONS:

Among older women with DCIS who received BCS, SLNB use was associated with higher risks of short-term complications. These findings support consensus guidelines recommending against SLNB for this population and provide empirical information for patients.

PMID:
29516364
PMCID:
PMC5928184
DOI:
10.1245/s10434-018-6410-0
[Indexed for MEDLINE]
Free PMC Article

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