title: Surgeon bias in sentinel lymph node dissection: Do tumor characteristics influence decision making?
abstract: BACKGROUND
  Determining sentinel lymph nodes (SLNs) in breast cancer staging involves subjective interpretation by the surgeon. We hypothesized patient and tumor characteristics influence number of SLNs harvested.
  
  
  METHODS
  A single-institution, prospectively collected database was queried for breast cancer patients undergoing SLN surgery (2002-2013) and mean SLN counts were compared.
  
  
  RESULTS
  There were 2394 SLN biopsies. Mean number of SLNs per patient for the entire cohort was 2.6. Mean number of SLNs removed was greater for patients ≤50 years (2.9 versus 2.6; p < 0.0001). Fewer SLNs were removed with tumors ≤1 cm (2.5 versus 2.6; p = 0.002). Patients with grades 2 or 3 tumors had more SLNs removed than grade 1 (2.6 versus 2.5; p = 0.03). Receipt of neoadjuvant therapy was associated with more SLNs removed (3.0 versus 2.6; p = 0.005).
  
  
  CONCLUSIONS
  Number of SLNs removed varies based on risk factors for SLN metastasis or false-negative SLN biopsy.
authors.affiliation: Division of Surgical Oncology, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, United States. Electronic address: krob1333@gmail.com.
authors.forename: Kristin A
authors.initials: KA
authors.lastname: Robinson
authors.affiliation: Division of Surgical Oncology, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, United States. Electronic address: Pockaj.Barbara@mayo.edu.
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Pockaj
authors.affiliation: Division of Surgical Oncology, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, United States. Electronic address: Wasif.Nabil@mayo.edu.
authors.forename: Nabil
authors.initials: N
authors.lastname: Wasif
authors.affiliation: Arizona State University, 1151 S Forest Ave, Tempe, AZ 85287, United States. Electronic address: Katie.K704@hotmail.com.
authors.forename: Katie
authors.initials: K
authors.lastname: Kaufman
authors.affiliation: Division of Surgical Oncology, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, United States. Electronic address: Gray.Richard@mayo.edu.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Gray
mesh_terms: D000367:Age Factors; D000368:Aged; D001365:Axilla; D015982:Bias; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000473:pathology / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology / Q000601:surgery*; D018275:Carcinoma, Lobular / Q000473:pathology / Q000601:surgery*; D016208:Databases, Factual; D003657:Decision Making; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods / Q000706:statistics & numerical data; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000706:statistics & numerical data*; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011446:Prospective Studies; D021701:Sentinel Lymph Node Biopsy / Q000379:methods / Q000706:statistics & numerical data*; D047368:Tumor Burden
keywords: Breast cancer staging; Sentinel lymph node biopsy; Surgeon bias