Assessment of hospital-level adjusted breast cancer sentinel lymph node positivity rates

Elizabeth R. Berger, Karl Y Bilimoria, Christine V. Kinnier, Christina A. Minami, Kevin P Bethke, Nora M Hansen, Ryan Patrick Merkow, David P. Winchester, Anthony D Yang

Research output: Contribution to journalArticle

Abstract

Background/Objectives: Proficiency of performing sentinel lymph node biopsy (SLNB) for breast cancer varies among hospitals and may be reflected in the hospital's SLNB positivity rate. Our objectives were to examine whether hospital characteristics are associated with variation in SLNB positivity rates and whether hospitals with lower-than-expected SLNB positivity rates have worse patient survival. Methods: Using the National Cancer Data Base, stage I to III breast cancer patients were identified (2004-2012). Hospital-level SLNB positivity rates were adjusted for tumor and patient factors. Hospitals were divided into terciles of SLNB positivity rates (lower-, higher-, as-expected). Hospital characteristics and survival were examined across terciles. Results: Of 438 610 SLNB patients (from 1357 hospitals), 78 104 had one or more positive SLN (21.3%). Hospitals in the low and high terciles were more likely to be low volume (low: RRR, 4.40; 95% CI, 2.89-6.57; P < 0.001; and high: RRR, 1.79; 95% CI, 1.21-2.64; P < 0.001) compared to hospitals with as-expected (middle tercile) SLNB positivity rates. Stage I patients at low- and high-tercile hospitals had statistically worse survival. Conclusions: There is a wide variation in hospital SLNB positivity rates. Hospitals with lower- or higher-than-expected SLNB positivity rates were associated with survival differences. Hospital SLNB positivity rates may be a novel ‘process measure’ to report to hospitals for internal quality assessment.

Original languageEnglish (US)
Pages (from-to)101-108
Number of pages8
JournalJournal of Surgical Oncology
Volume119
Issue number1
DOIs
StatePublished - Jan 1 2019

Fingerprint

Sentinel Lymph Node Biopsy
Breast Neoplasms
Survival
Sentinel Lymph Node
Process Assessment (Health Care)
Neoplasms
Databases

Keywords

  • breast cancer
  • health outcomes
  • node biopsy
  • process measures
  • quality metric
  • sentinel lymph

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

@article{09d766bfbd534ee490ac217983653ba6,
title = "Assessment of hospital-level adjusted breast cancer sentinel lymph node positivity rates",
abstract = "Background/Objectives: Proficiency of performing sentinel lymph node biopsy (SLNB) for breast cancer varies among hospitals and may be reflected in the hospital's SLNB positivity rate. Our objectives were to examine whether hospital characteristics are associated with variation in SLNB positivity rates and whether hospitals with lower-than-expected SLNB positivity rates have worse patient survival. Methods: Using the National Cancer Data Base, stage I to III breast cancer patients were identified (2004-2012). Hospital-level SLNB positivity rates were adjusted for tumor and patient factors. Hospitals were divided into terciles of SLNB positivity rates (lower-, higher-, as-expected). Hospital characteristics and survival were examined across terciles. Results: Of 438 610 SLNB patients (from 1357 hospitals), 78 104 had one or more positive SLN (21.3{\%}). Hospitals in the low and high terciles were more likely to be low volume (low: RRR, 4.40; 95{\%} CI, 2.89-6.57; P < 0.001; and high: RRR, 1.79; 95{\%} CI, 1.21-2.64; P < 0.001) compared to hospitals with as-expected (middle tercile) SLNB positivity rates. Stage I patients at low- and high-tercile hospitals had statistically worse survival. Conclusions: There is a wide variation in hospital SLNB positivity rates. Hospitals with lower- or higher-than-expected SLNB positivity rates were associated with survival differences. Hospital SLNB positivity rates may be a novel ‘process measure’ to report to hospitals for internal quality assessment.",
keywords = "breast cancer, health outcomes, node biopsy, process measures, quality metric, sentinel lymph",
author = "Berger, {Elizabeth R.} and Bilimoria, {Karl Y} and Kinnier, {Christine V.} and Minami, {Christina A.} and Bethke, {Kevin P} and Hansen, {Nora M} and Merkow, {Ryan Patrick} and Winchester, {David P.} and Yang, {Anthony D}",
year = "2019",
month = "1",
day = "1",
doi = "10.1002/jso.25294",
language = "English (US)",
volume = "119",
pages = "101--108",
journal = "Journal of Surgical Oncology",
issn = "0022-4790",
publisher = "Wiley-Liss Inc.",
number = "1",

}

Assessment of hospital-level adjusted breast cancer sentinel lymph node positivity rates. / Berger, Elizabeth R.; Bilimoria, Karl Y; Kinnier, Christine V.; Minami, Christina A.; Bethke, Kevin P; Hansen, Nora M; Merkow, Ryan Patrick; Winchester, David P.; Yang, Anthony D.

In: Journal of Surgical Oncology, Vol. 119, No. 1, 01.01.2019, p. 101-108.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Assessment of hospital-level adjusted breast cancer sentinel lymph node positivity rates

AU - Berger, Elizabeth R.

AU - Bilimoria, Karl Y

AU - Kinnier, Christine V.

AU - Minami, Christina A.

AU - Bethke, Kevin P

AU - Hansen, Nora M

AU - Merkow, Ryan Patrick

AU - Winchester, David P.

AU - Yang, Anthony D

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background/Objectives: Proficiency of performing sentinel lymph node biopsy (SLNB) for breast cancer varies among hospitals and may be reflected in the hospital's SLNB positivity rate. Our objectives were to examine whether hospital characteristics are associated with variation in SLNB positivity rates and whether hospitals with lower-than-expected SLNB positivity rates have worse patient survival. Methods: Using the National Cancer Data Base, stage I to III breast cancer patients were identified (2004-2012). Hospital-level SLNB positivity rates were adjusted for tumor and patient factors. Hospitals were divided into terciles of SLNB positivity rates (lower-, higher-, as-expected). Hospital characteristics and survival were examined across terciles. Results: Of 438 610 SLNB patients (from 1357 hospitals), 78 104 had one or more positive SLN (21.3%). Hospitals in the low and high terciles were more likely to be low volume (low: RRR, 4.40; 95% CI, 2.89-6.57; P < 0.001; and high: RRR, 1.79; 95% CI, 1.21-2.64; P < 0.001) compared to hospitals with as-expected (middle tercile) SLNB positivity rates. Stage I patients at low- and high-tercile hospitals had statistically worse survival. Conclusions: There is a wide variation in hospital SLNB positivity rates. Hospitals with lower- or higher-than-expected SLNB positivity rates were associated with survival differences. Hospital SLNB positivity rates may be a novel ‘process measure’ to report to hospitals for internal quality assessment.

AB - Background/Objectives: Proficiency of performing sentinel lymph node biopsy (SLNB) for breast cancer varies among hospitals and may be reflected in the hospital's SLNB positivity rate. Our objectives were to examine whether hospital characteristics are associated with variation in SLNB positivity rates and whether hospitals with lower-than-expected SLNB positivity rates have worse patient survival. Methods: Using the National Cancer Data Base, stage I to III breast cancer patients were identified (2004-2012). Hospital-level SLNB positivity rates were adjusted for tumor and patient factors. Hospitals were divided into terciles of SLNB positivity rates (lower-, higher-, as-expected). Hospital characteristics and survival were examined across terciles. Results: Of 438 610 SLNB patients (from 1357 hospitals), 78 104 had one or more positive SLN (21.3%). Hospitals in the low and high terciles were more likely to be low volume (low: RRR, 4.40; 95% CI, 2.89-6.57; P < 0.001; and high: RRR, 1.79; 95% CI, 1.21-2.64; P < 0.001) compared to hospitals with as-expected (middle tercile) SLNB positivity rates. Stage I patients at low- and high-tercile hospitals had statistically worse survival. Conclusions: There is a wide variation in hospital SLNB positivity rates. Hospitals with lower- or higher-than-expected SLNB positivity rates were associated with survival differences. Hospital SLNB positivity rates may be a novel ‘process measure’ to report to hospitals for internal quality assessment.

KW - breast cancer

KW - health outcomes

KW - node biopsy

KW - process measures

KW - quality metric

KW - sentinel lymph

UR - http://www.scopus.com/inward/record.url?scp=85057335585&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85057335585&partnerID=8YFLogxK

U2 - 10.1002/jso.25294

DO - 10.1002/jso.25294

M3 - Article

VL - 119

SP - 101

EP - 108

JO - Journal of Surgical Oncology

T2 - Journal of Surgical Oncology

JF - Journal of Surgical Oncology

SN - 0022-4790

IS - 1

ER -