Surgeon specialization and use of sentinel lymph node biopsy for breast cancer.
Identifieur interne : 001757 ( PubMed/Corpus ); précédent : 001756; suivant : 001758Surgeon specialization and use of sentinel lymph node biopsy for breast cancer.
Auteurs : Tina W F. Yen ; Purushuttom W. Laud ; Rodney A. Sparapani ; Ann B. NattingerSource :
- JAMA surgery [ 2168-6262 ] ; 2014.
English descriptors
- KwdEn :
- Aged, Aged, 80 and over, Axilla, Breast Neoplasms (secondary), Breast Neoplasms (surgery), Clinical Competence, Female, Follow-Up Studies, Humans, Lymph Node Excision (standards), Lymphatic Metastasis, Male, Neoplasm Staging (methods), Physicians (standards), Prospective Studies, Registries, Sentinel Lymph Node Biopsy (standards), Sentinel Lymph Node Biopsy (utilization), Specialization, Specialties, Surgical (standards), United States.
- MESH :
- geographic : United States.
- methods : Neoplasm Staging.
- secondary : Breast Neoplasms.
- standards : Lymph Node Excision, Physicians, Sentinel Lymph Node Biopsy, Specialties, Surgical.
- surgery : Breast Neoplasms.
- utilization : Sentinel Lymph Node Biopsy.
- Aged, Aged, 80 and over, Axilla, Clinical Competence, Female, Follow-Up Studies, Humans, Lymphatic Metastasis, Male, Prospective Studies, Registries, Specialization.
Abstract
Sentinel lymph node biopsy (SLNB) is the standard of care for axillary staging in patients with clinically node-negative breast cancer. It is not known whether SLNB rates differ by surgeon expertise. If surgeons with less breast cancer expertise are less likely to offer SLNB to these patients, this practice pattern could lead to unnecessary axillary lymph node dissections and lymphedema.
DOI: 10.1001/jamasurg.2013.4350
PubMed: 24369337
Links to Exploration step
pubmed:24369337Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Surgeon specialization and use of sentinel lymph node biopsy for breast cancer.</title><author><name sortKey="Yen, Tina W F" sort="Yen, Tina W F" uniqKey="Yen T" first="Tina W F" last="Yen">Tina W F. Yen</name><affiliation><nlm:affiliation>Division of Surgical Oncology, Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee.</nlm:affiliation></affiliation></author><author><name sortKey="Laud, Purushuttom W" sort="Laud, Purushuttom W" uniqKey="Laud P" first="Purushuttom W" last="Laud">Purushuttom W. Laud</name><affiliation><nlm:affiliation>Division of Biostatistics, Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee.</nlm:affiliation></affiliation></author><author><name sortKey="Sparapani, Rodney A" sort="Sparapani, Rodney A" uniqKey="Sparapani R" first="Rodney A" last="Sparapani">Rodney A. Sparapani</name><affiliation><nlm:affiliation>Division of Biostatistics, Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee.</nlm:affiliation></affiliation></author><author><name sortKey="Nattinger, Ann B" sort="Nattinger, Ann B" uniqKey="Nattinger A" first="Ann B" last="Nattinger">Ann B. Nattinger</name><affiliation><nlm:affiliation>Department of Medicine, Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee.</nlm:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2014">2014</date><idno type="RBID">pubmed:24369337</idno><idno type="pmid">24369337</idno><idno type="doi">10.1001/jamasurg.2013.4350</idno><idno type="wicri:Area/PubMed/Corpus">001757</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Corpus" wicri:corpus="PubMed">001757</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Surgeon specialization and use of sentinel lymph node biopsy for breast cancer.</title><author><name sortKey="Yen, Tina W F" sort="Yen, Tina W F" uniqKey="Yen T" first="Tina W F" last="Yen">Tina W F. Yen</name><affiliation><nlm:affiliation>Division of Surgical Oncology, Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee.</nlm:affiliation></affiliation></author><author><name sortKey="Laud, Purushuttom W" sort="Laud, Purushuttom W" uniqKey="Laud P" first="Purushuttom W" last="Laud">Purushuttom W. Laud</name><affiliation><nlm:affiliation>Division of Biostatistics, Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee.</nlm:affiliation></affiliation></author><author><name sortKey="Sparapani, Rodney A" sort="Sparapani, Rodney A" uniqKey="Sparapani R" first="Rodney A" last="Sparapani">Rodney A. Sparapani</name><affiliation><nlm:affiliation>Division of Biostatistics, Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee.</nlm:affiliation></affiliation></author><author><name sortKey="Nattinger, Ann B" sort="Nattinger, Ann B" uniqKey="Nattinger A" first="Ann B" last="Nattinger">Ann B. Nattinger</name><affiliation><nlm:affiliation>Department of Medicine, Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee.</nlm:affiliation></affiliation></author></analytic><series><title level="j">JAMA surgery</title><idno type="eISSN">2168-6262</idno><imprint><date when="2014" type="published">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Aged</term><term>Aged, 80 and over</term><term>Axilla</term><term>Breast Neoplasms (secondary)</term><term>Breast Neoplasms (surgery)</term><term>Clinical Competence</term><term>Female</term><term>Follow-Up Studies</term><term>Humans</term><term>Lymph Node Excision (standards)</term><term>Lymphatic Metastasis</term><term>Male</term><term>Neoplasm Staging (methods)</term><term>Physicians (standards)</term><term>Prospective Studies</term><term>Registries</term><term>Sentinel Lymph Node Biopsy (standards)</term><term>Sentinel Lymph Node Biopsy (utilization)</term><term>Specialization</term><term>Specialties, Surgical (standards)</term><term>United States</term></keywords><keywords scheme="MESH" type="geographic" xml:lang="en"><term>United States</term></keywords><keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Neoplasm Staging</term></keywords><keywords scheme="MESH" qualifier="secondary" xml:lang="en"><term>Breast Neoplasms</term></keywords><keywords scheme="MESH" qualifier="standards" xml:lang="en"><term>Lymph Node Excision</term><term>Physicians</term><term>Sentinel Lymph Node Biopsy</term><term>Specialties, Surgical</term></keywords><keywords scheme="MESH" qualifier="surgery" xml:lang="en"><term>Breast Neoplasms</term></keywords><keywords scheme="MESH" qualifier="utilization" xml:lang="en"><term>Sentinel Lymph Node Biopsy</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Aged</term><term>Aged, 80 and over</term><term>Axilla</term><term>Clinical Competence</term><term>Female</term><term>Follow-Up Studies</term><term>Humans</term><term>Lymphatic Metastasis</term><term>Male</term><term>Prospective Studies</term><term>Registries</term><term>Specialization</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Sentinel lymph node biopsy (SLNB) is the standard of care for axillary staging in patients with clinically node-negative breast cancer. It is not known whether SLNB rates differ by surgeon expertise. If surgeons with less breast cancer expertise are less likely to offer SLNB to these patients, this practice pattern could lead to unnecessary axillary lymph node dissections and lymphedema.</div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">24369337</PMID><DateCreated><Year>2014</Year><Month>02</Month><Day>20</Day></DateCreated><DateCompleted><Year>2014</Year><Month>04</Month><Day>15</Day></DateCompleted><DateRevised><Year>2016</Year><Month>10</Month><Day>19</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Electronic">2168-6262</ISSN><JournalIssue CitedMedium="Internet"><Volume>149</Volume><Issue>2</Issue><PubDate><Year>2014</Year><Month>Feb</Month></PubDate></JournalIssue><Title>JAMA surgery</Title><ISOAbbreviation>JAMA Surg</ISOAbbreviation></Journal><ArticleTitle>Surgeon specialization and use of sentinel lymph node biopsy for breast cancer.</ArticleTitle><Pagination><MedlinePgn>185-92</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1001/jamasurg.2013.4350</ELocationID><Abstract><AbstractText Label="IMPORTANCE" NlmCategory="OBJECTIVE">Sentinel lymph node biopsy (SLNB) is the standard of care for axillary staging in patients with clinically node-negative breast cancer. It is not known whether SLNB rates differ by surgeon expertise. If surgeons with less breast cancer expertise are less likely to offer SLNB to these patients, this practice pattern could lead to unnecessary axillary lymph node dissections and lymphedema.</AbstractText><AbstractText Label="OBJECTIVE" NlmCategory="OBJECTIVE">To explore potential measures of surgical expertise (including a novel objective specialization measure: percentage of a surgeon's operations performed for breast cancer determined from Medicare claims) on the use of SLNB for invasive breast cancer.</AbstractText><AbstractText Label="DESIGN, SETTING, AND POPULATION" NlmCategory="METHODS">A population-based prospective cohort study was conducted in California, Florida, and Illinois. Participants included elderly (65-89 years) women identified from Medicare claims as having had incident invasive breast cancer surgery in 2003. Patient, tumor, treatment, and surgeon characteristics were examined.</AbstractText><AbstractText Label="MAIN OUTCOME AND MEASURE" NlmCategory="METHODS">Type of axillary surgery performed.</AbstractText><AbstractText Label="RESULTS" NlmCategory="RESULTS">Of 1703 women who received treatment by 863 surgeons, 56.4% underwent an initial SLNB, 37.2% initial axillary lymph node dissection, and 6.3% no axillary surgery. The median annual surgeon Medicare volume of breast cancer cases was 6.0 (range, 1.5-57.0); the median surgeon percentage of breast cancer cases was 4.5% (range, 0.4%-100.0%). After multivariable adjustment of patient and surgeon factors, women operated on by surgeons with higher volumes and percentages of breast cancer cases had a higher likelihood of undergoing SLNB. Specifically, women were most likely to undergo SLNB if the operation was performed by high-volume surgeons (regardless of percentage) or by lower-volume surgeons with a high percentage of breast cancer cases. In addition, membership in the American Society of Breast Surgeons (odds ratio, 1.98; 95% CI, 1.51-2.60) and Society of Surgical Oncology (1.59; 1.09-2.30) were independent predictors of women undergoing an initial SLNB.</AbstractText><AbstractText Label="CONCLUSIONS AND RELEVANCE" NlmCategory="CONCLUSIONS">Patients who receive treatment from surgeons with more experience with and focus on breast cancer are significantly more likely to undergo SLNB, highlighting the importance of receiving initial treatment by specialized providers. Factors relating to specialization in a particular area, including our novel surgeon percentage measure, require further investigation as potential indicators of quality of care.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Yen</LastName><ForeName>Tina W F</ForeName><Initials>TW</Initials><AffiliationInfo><Affiliation>Division of Surgical Oncology, Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Laud</LastName><ForeName>Purushuttom W</ForeName><Initials>PW</Initials><AffiliationInfo><Affiliation>Division of Biostatistics, Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Sparapani</LastName><ForeName>Rodney A</ForeName><Initials>RA</Initials><AffiliationInfo><Affiliation>Division of Biostatistics, Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Nattinger</LastName><ForeName>Ann B</ForeName><Initials>AB</Initials><AffiliationInfo><Affiliation>Department of Medicine, Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><GrantList CompleteYN="Y"><Grant><GrantID>R01 CA127648</GrantID><Acronym>CA</Acronym><Agency>NCI NIH HHS</Agency><Country>United States</Country></Grant><Grant><GrantID>K07CA125586</GrantID><Acronym>CA</Acronym><Agency>NCI NIH HHS</Agency><Country>United States</Country></Grant><Grant><GrantID>R01CA127648</GrantID><Acronym>CA</Acronym><Agency>NCI NIH HHS</Agency><Country>United States</Country></Grant><Grant><GrantID>K07 CA125586</GrantID><Acronym>CA</Acronym><Agency>NCI NIH HHS</Agency><Country>United States</Country></Grant><Grant><GrantID>R01 CA081379</GrantID><Acronym>CA</Acronym><Agency>NCI NIH HHS</Agency><Country>United States</Country></Grant><Grant><GrantID>K07CA125586-03S1</GrantID><Acronym>CA</Acronym><Agency>NCI NIH HHS</Agency><Country>United States</Country></Grant><Grant><GrantID>R01CA81379</GrantID><Acronym>CA</Acronym><Agency>NCI NIH HHS</Agency><Country>United States</Country></Grant></GrantList><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D016448">Multicenter Study</PublicationType><PublicationType UI="D052061">Research Support, N.I.H., Extramural</PublicationType></PublicationTypeList></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>JAMA Surg</MedlineTA><NlmUniqueID>101589553</NlmUniqueID><ISSNLinking>2168-6254</ISSNLinking></MedlineJournalInfo><CitationSubset>AIM</CitationSubset><CitationSubset>IM</CitationSubset><CommentsCorrectionsList><CommentsCorrections RefType="Cites"><RefSource>Ann Surg. 2005 Jul;242(1):1-6; 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MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005500" MajorTopicYN="N">Follow-Up Studies</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008197" MajorTopicYN="N">Lymph Node Excision</DescriptorName><QualifierName UI="Q000592" MajorTopicYN="N">standards</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D008207" MajorTopicYN="N">Lymphatic Metastasis</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D009367" MajorTopicYN="N">Neoplasm Staging</DescriptorName><QualifierName UI="Q000379" MajorTopicYN="Y">methods</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D010820" MajorTopicYN="N">Physicians</DescriptorName><QualifierName UI="Q000592" 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