Abstract
Background In 2025, the Commission on Cancer (CoC) issued a quality measure recommending omission of sentinel node biopsy (SNB) in women 70 and over with cT1N0, hormone receptor positive (HR+), HER2neu negative invasive breast cancer undergoing breast conserving surgery. We examined historical performance of this measure. Methods Trends in omission of SNB and estimated performance rates (EPR) by facility (the proportion of patients in whom SNB was omitted at a facility) were examined from 2012-2023. Multivariate analysis demonstrated facility factors most strongly associated with median compliance rate of 25%. Results A total of 185,859 patients from the National Cancer Data Base (NCDB) met the aforementioned inclusion criteria. From 2012-2023, SNB was omitted in 43,513 (23.4%) of eligible patients. SNB omission rates were 14% in 2012 versus 44% in 2023. An EPR of 30% was achieved by 655 (52.9%) CoC facilities, 40% by 516 (41.9%) facilities, 50% by 393 (31.7%) facilities, 60% by 278 (22.5%) facilities, 70% by 155 (12.5%) facilities, and 80% by only 85 (6.9%) facilities from 2021-2023. Facilities with > 50% private insurance (OR 1.7, 95% CI:1.23-2.34), academic/teaching designation (OR 2.12, 95% CI:1.36-3.3), high volume (> 250 annual cases) (OR 2.07, 95% CI:1.35-3.18) and in certain census areas of the country were significantly associated with higher likelihood of achieving 25% EPR, the median EPR amongst all site, on multivariate analysis (p < 0.05). Conclusion SNB was omitted on less than half of eligible HR+, HER2neu negative early-stage breast cancer patients over age 70 in 2023, indicating an opportunity for quality improvement.