Rural and urban disparities in the evolution of sentinel lymph node utilization in breast cancer
Rural and urban disparities in the evolution of sentinel lymph node utilization in breast cancer
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DOI：
10.1016/j.amjsurg.2013.07.007
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发表时间：
2013-11-01
影响因子：
3
通讯作者：
Chen, Steven L.
中科院分区：
文献类型：
--
作者：
Arrington, Amanda K.;Kruper, Laura;Chen, Steven L.
背景：前哨淋巴结活检（SLNB）已成为腋窝淋巴结分期的首选方法。作者检查了城市和农村地区采用该程序时的 SLNB 利用率，并假设城市人口中的 SLNB 率增长较快，而农村中心的 SLNB 技术转变和接受程度较慢。方法：使用监测、流行病学和最终结果数据库来识别 1998 年至 2008 年间诊断的浸润性淋巴结阴性导管癌或小叶乳腺癌患者。排除标准为远处转移性疾病、T4 肿瘤或不完全转移数据。居住环境根据人口密度进行分组。结果：SLNB 的总体发生率随着时间的推移而增加（从 1998 年的 10% 到 2008 年的 73%）。农村地区采用 SLNB 的速度慢于城市人口 (P < .001)。到 2003 年，只有城市地区超过 50% 的病例使用前哨淋巴结活检。总体而言，这些群体的 SLNB 使用率的增长存在 2 年的滞后。根据肿瘤大小，SLNB 率存在显着差异。结论：2004 年，SLNB 总体率保持在 50% 左右，并且在农村地区较低。到 2008 年，所有人群类别中 T1 和 T2 肿瘤的 SLNB 率已增加至 > 50%。随着肿瘤大小的增加，所有人群中 SLNB 的利用率均较低。在人口较少的地区，SLNB 的采用总体滞后了 2 年。尽管这可能代表了一种更为保守的方法，但这种差异可能是由于缺乏经验丰富的外科医生、缺乏培训或较小机构缺乏技术支持。 (C) 2013 Elsevier Inc. 保留所有权利。
BACKGROUND: Sentinel lymph node biopsy (SLNB) has become the preferred method for axillary nodal staging. The authors examined SLNB utilization in urban versus rural settings as this procedure was adopted and hypothesized that SLNB rates among urban populations increased faster, while the technology shift and acceptance of SLNB were slower at rural centers.METHODS: The Surveillance, Epidemiology and End Results database was used to identify patients with invasive node-negative ductal or lobular breast cancer diagnosed from 1998 to 2008. Exclusion criteria were distant metastatic disease, T4 tumors, or incomplete data. Residential setting was divided into groups on the basis of population density.RESULTS: The overall rate of SLNB increased with time (from 10% in 1998 to 73% in 2008). The adoption of SLNB was slower in rural settings than among urban populations (P < .001). By 2003, only urban areas were using SLNB in >50% of cases. Overall, there was a 2-year lag between the increases in SLNB utilization rates in these groups. There was a significant difference in SLNB rates according to tumor size.CONCLUSION: The overall rate of SLNB remained near 50% and was lower in rural locations in 2004. By 2008, the SLNB rate for T1 and T2 tumors had increased to >50% in all population categories. SLNB utilization was lower in all population categories as tumor size increased. There was an overall 2-year lag in the adoption of SLNB in less populated areas. Although this may represent a more conservative approach, the difference may be attributable to a shortage of experienced surgeons, lack of training, or lack of technological support at smaller institutions. (C) 2013 Elsevier Inc. All rights reserved.