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Should you have extensive axillary lymph node dissection if you have Stage I breast cancer (DCIS)? Or should you only have sentinel lymph node surgery?

A new study published in JAMA Oncology looked at whether experienced surgeons are more likely to do less extensive lymph node evaluation than less experienced surgeons, in patients with ductal carcinoma in situ (DCIS) breast cancer.  This study also looked at whether high volume hospitals do less extensive lymph node dissection than hospitals with lower volume of breast surgeries.

According to the American Society of Clinical Oncology (ASCO), women who have lumpectomy to remove DCIS should not have any lymph nodes removed, unless the DCIS is large or a suspicious mass is found during lumpectomy surgery.  For women who have mastectomy to remove DCIS, ASCO recommends only sentinel lymph node surgery, and not axillary node surgery.  In sentinel lymph node surgery (also known as sentinel lymph node dissection), only the one or two lymph nodes closest to the cancer are removed for biopsy and sent to a pathologust for evaluation.  In axillary node dissection surgery, the surgeon removes between 5 and 30 lymph nodes or more from the armpit area.

This study found that surgeons who do a lot of breast cancer surgery are much less likely to perform extensive, axillary lymph node dissection than surgeons who do a lesser number of breast cancer surgeries.  In other word, high volume surgeons are more likely to follow the ASCO guidelines than the low volume surgeons.  Also, the study found that hospitals that do a lot of breast cancer surgery are much less likely to perform extensive, axillary lymph node dissection than hospitals who have a low volume of breast cancer surgery.