Sentinel lymph node biopsy guideline concordance in melanoma: Analysis of the National Cancer Database

• Published in: Journal of surgical oncology Vol. 124; no. 4; pp. 669 - 678
• Main Authors: Narang, Jatin, Hue, Jonathan J., Bingmer, Katherine, Hardacre, Jeffrey M., Winter, Jordan M., Ocuin, Lee M., Ammori, John B., Mangla, Ankit, Bordeaux, Jeremy, Rothermel, Luke D.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc 01-09-2021
• Subjects: Biopsy; disparity; guideline concordance; Lymphatic system; Melanoma; National Cancer Database; NCCN guidelines; sentinel lymph node biopsy
• ISSN: 0022-4790; 1096-9098
• DOI: 10.1002/jso.26565

Background and Objectives
This study investigated the impact of treating facility type on guideline‐concordant sentinel lymph node biopsy (SLNB) management in T1a* (defined as a Breslow depth <0.76 mm without ulceration or mitoses) and T2/T3 melanoma.
Methods
This was a retrospective cohort study utilizing the National Cancer Database from 2012 to 2016.
Results
Our cohort included 109,432 patients. For T1a* melanomas, 85% of patients received guideline‐concordant SLNB management at community and academic facilities versus 75% of patients at integrated network facilities (p < .001). Over 83% of patients with T2/T3 melanoma treated at an academic facility received guideline‐concordant SLNB management versus 77% treated at a community facility (p < .001). Adjusting for demographic and clinical factors, integrated (adjusted odds ratio, aOR = 0.54), and comprehensive community (aOR = 0.74) facilities were less likely to provide guideline‐concordant SLNB management in patients with T1a* melanoma compared to academic facilities. Community facilities (aOR = 0.72) were less likely to provide guideline‐concordant SLNB management in patients with T2/T3 melanoma compared to academic facilities.
Conclusion
Academic facilities provide the highest rate of guideline‐concordant sentinel lymph node management. Comparatively, community programs may underutilize SLNB in T2/T3 disease, while integrated and comprehensive community facilities may over‐utilize SLNB in T1a* disease.