Morrow M, et al. - Researchers investigated surgeon acceptance of the findings of American College of Surgeons Oncology Group (ACOSOG) Z0011 study, which reported the safety of sentinel node biopsy alone in clinically node-negative women with metastases in 1 or 2 sentinel nodes treated with breast conservation. They also determined the characteristics related to acceptance of ACOSOG Z0011 results and assessed the link between acceptance of the Society of Surgical Oncology and American Society for Radiation Oncology negative margin of no ink on tumor and surgeon preference for axillary lymph node dissection (ALND). Regarding surgeon acceptance of more limited surgery for breast cancer, a substantial variation was observed, which was linked to higher breast cancer volume and multidisciplinary interactions. These findings point towards the potential for overtreatment of many patients and the need for education targeting lower-volume breast surgeons.

Methods

• In this study conducted from July 1, 2013 to August 31, 2015, researchers performed a survey in 488 surgeons treating a population-based sample of women with early-stage breast cancer (N=5,080).
• They categorized surgeons as having low, intermediate, or high propensity for ALND according to the outer quartiles of ALND scale distribution.
• They used a multivariable linear regression model to confirm independent links.

Results

• Out of the 488 surgeons who were sent a survey, a response was obtained from 376 (77.0%) and 359 gave complete information about tendency for ALND resulting from 5 clinical scenarios.
• Mean surgeon age was 53.7 (range, 31-80) years, 277 (73.7%) were male, 142 (37.8%) treated 20 or fewer breast cancers annually, and 108 (28.7%) treated more than 50.
• For 1 macrometastasis, ALND was recommended by 175 (49.0%) surgeons.
• Relative to 69 (38.6%) and 85 (95.5%) selective and high-propensity surgeons (P<.001), respectively, only 1 (1.1%) low-propensity surgeon who recommended ALND approved ALND for any nodal metastases.
• Multivariable analysis revealed a significant association of lower ALND propensity with higher breast cancer volume (21-50: -0.19; 95% CI, -0.39 to 0.02; > 51: -0.48; 95% CI, -0.71 to -0.24; P < .001), recommendation of a minimal margin width (1-5 mm: -0.10; 95% CI, -0.43 to 0.22; no ink on tumor: -0.53; 95% CI, -0.82 to -0.24; P < .001), participation in a multidisciplinary tumor board (1%-9%: -0.25; 95% CI, -0.55 to 0.05; >9%: -0.37; 95% CI, -0.63 to -0.11; P=.02), and Los Angeles Surveillance, Epidemiology, and End Results site (-0.18; 95% CI, -0.35 to -0.01; P=.04).