title: Initial axillary surgery: results from the BreastSurgANZ Quality Audit.
abstract: BACKGROUND
  The aim of this study was to establish the preference and reasons for initial axillary surgery performed on women with invasive breast cancer in Australia and New Zealand using data from the Breast Surgeon's Society of Australia and New Zealand Quality Audit (BQA) according to whether sentinel lymph node (SLN) biopsy, axillary lymph node dissection (ALND) or no axillary surgery was used.
  
  
  METHODS
  Patient data from 1999 to 2011 were categorized according to primary tumour size (≤3 cm or >3 cm) and analysed by year of diagnosis, type of initial axillary surgery and frequency of second axillary surgery following SLN biopsy. Patient age at diagnosis, health insurance status, surgeon caseload and hospital location were also examined as factors affecting the likelihood of performing different types of axillary surgery.
  
  
  RESULTS
  Seventy thousand six hundred and eighty-eight episodes of early breast cancer with axillary surgery data were reported to the BQA in the study period. The proportion of patients undergoing SLN biopsy as the first operation increased over this period in both tumour size groups with a concomitant decline in the use of ALND as the first operation over the same interval. Elderly women (>70 years old) were four times less likely to undergo axillary surgery for their initial management when compared with women aged 41-70 years old (P < 0.001). Factors favouring ALND as the initial surgery over SLN biopsy included larger tumour size, elderly age, uninsured status and having surgery in a regional centre.
  
  
  CONCLUSIONS
  From 1999 to 2011, SLN biopsy as the initial axillary surgery has been widely adopted by surgeons reporting to the BQA. Future evaluation of the BQA data in the following 3-5 years will be performed to monitor this progression.
authors.affiliation: Department of Surgery, The Queen Elizabeth Hospital, Woodville West, South Australia, Australia.
authors.forename: Chilton
authors.initials: C
authors.lastname: Chong
authors.affiliation: Department of Surgery, The Queen Elizabeth Hospital, Woodville West, South Australia, Australia.|BreastSurgANZ Quality Audit, Australian Safety and Efficacy Register of New Interventional Procedures - Surgical (ASERNIP-S), Royal Australasian College of Surgeons, North Adelaide, South Australia, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Walters
authors.affiliation: BreastSurgANZ Quality Audit, Australian Safety and Efficacy Register of New Interventional Procedures - Surgical (ASERNIP-S), Royal Australasian College of Surgeons, North Adelaide, South Australia, Australia.
authors.forename: Primali
authors.initials: P
authors.lastname: de Silva
authors.affiliation: BreastSurgANZ Quality Audit, Australian Safety and Efficacy Register of New Interventional Procedures - Surgical (ASERNIP-S), Royal Australasian College of Surgeons, North Adelaide, South Australia, Australia.
authors.forename: Corey
authors.initials: C
authors.lastname: Taylor
authors.affiliation: University of Sydney, Breast & Surgical Oncology at the Poche Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Spillane
authors.affiliation: Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
authors.forename: James
authors.initials: J
authors.lastname: Kollias
authors.affiliation: Department of Surgery, Mater Hospital, South Brisbane, Queensland, Australia.
authors.forename: Chris
authors.initials: C
authors.lastname: Pyke
authors.affiliation: Faculty of Medical and Health Sciences, Waikato Clinical School, University of Auckland, Auckland, New Zealand.
authors.forename: Ian
authors.initials: I
authors.lastname: Campbell
authors.affiliation: National Quality Audit, Australian Safety and Efficacy Register of New Interventional Procedures - Surgical (ASERNIP-S), Royal Australasian College of Surgeons, North Adelaide, South Australia, Australia.
authors.forename: Guy
authors.initials: G
authors.lastname: Maddern
mesh_terms: D000328:Adult; D000368:Aged; D001315:Australia; D001365:Axilla / Q000473:pathology / Q000601:surgery; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery*; D008485:Medical Audit; D008875:Middle Aged; D009520:New Zealand; D021701:Sentinel Lymph Node Biopsy / Q000379:methods
keywords: axillary lymph node dissection; breast cancer; breast surgery; sentinel lymph node biopsy; surgical oncology