{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T09:50:19Z","timestamp":1777888219860,"version":"3.51.4"},"reference-count":33,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2018,11,27]],"date-time":"2018-11-27T00:00:00Z","timestamp":1543276800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2018,11,27]],"date-time":"2018-11-27T00:00:00Z","timestamp":1543276800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Surgical Oncology"],"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background\/Objectives<\/jats:title>\n                    <jats:p>Proficiency of performing sentinel lymph node biopsy (SLNB) for breast cancer varies among hospitals and may be reflected in the hospital's SLNB positivity rate. Our objectives were to examine whether hospital characteristics are associated with variation in SLNB positivity rates and whether hospitals with lower\u2010than\u2010expected SLNB positivity rates have worse patient survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using the National Cancer Data Base, stage I to III breast cancer patients were identified (2004\u20102012). Hospital\u2010level SLNB positivity rates were adjusted for tumor and patient factors. Hospitals were divided into terciles of SLNB positivity rates (lower\u2010, higher\u2010, as\u2010expected). Hospital characteristics and survival were examined across terciles.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 438\u2009610 SLNB patients (from 1357 hospitals), 78 104 had one or more positive SLN (21.3%). Hospitals in the low and high terciles were more likely to be low volume (low: RRR, 4.40; 95% CI, 2.89\u20106.57;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001; and high: RRR, 1.79; 95% CI, 1.21\u20102.64;\n                      <jats:italic>P\u2009<\/jats:italic>\n                      &lt;\u20090.001) compared to hospitals with as\u2010expected (middle tercile) SLNB positivity rates. Stage I patients at low\u2010 and high\u2010tercile hospitals had statistically worse survival.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>There is a wide variation in hospital SLNB positivity rates. Hospitals with lower\u2010 or higher\u2010than\u2010expected SLNB positivity rates were associated with survival differences. Hospital SLNB positivity rates may be a novel \u2018process measure\u2019 to report to hospitals for internal quality assessment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jso.25294","type":"journal-article","created":{"date-parts":[[2018,11,27]],"date-time":"2018-11-27T14:04:21Z","timestamp":1543327461000},"page":"101-108","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Assessment of hospital\u2010level adjusted breast cancer sentinel lymph node positivity rates"],"prefix":"10.1002","volume":"119","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3857-1725","authenticated-orcid":false,"given":"Elizabeth R.","family":"Berger","sequence":"first","affiliation":[{"name":"The Division of Research and Optimal Patient Care, American College of Surgeons Chicago Illinois"},{"name":"Department of Surgery Loyola University Health System Maywood Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karl Y.","family":"Bilimoria","sequence":"additional","affiliation":[{"name":"Northwestern Institute for Comparatives Effectiveness Research (NICER) in Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University and Northwestern Memorial Hospital Chicago Illinois"},{"name":"Department of Surgery and Center for Healthcare Studies Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine and Northwestern Medicine, Northwestern University Chicago Illinois"},{"name":"Department of Surgery Division of Breast Surgery, Feinberg School of Medicine, Northwestern University Chicago Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine V.","family":"Kinnier","sequence":"additional","affiliation":[{"name":"Department of Surgery and Center for Healthcare Studies Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine and Northwestern Medicine, Northwestern University Chicago Illinois"},{"name":"Department of Surgery Massachusetts General Hospital Boston Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christina A.","family":"Minami","sequence":"additional","affiliation":[{"name":"Department of Surgery and Center for Healthcare Studies Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine and Northwestern Medicine, Northwestern University Chicago Illinois"},{"name":"Department of Surgery Division of Breast Surgery, Feinberg School of Medicine, Northwestern University Chicago Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin P.","family":"Bethke","sequence":"additional","affiliation":[{"name":"Department of Surgery Division of Breast Surgery, Feinberg School of Medicine, Northwestern University Chicago Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nora M.","family":"Hansen","sequence":"additional","affiliation":[{"name":"Department of Surgery Division of Breast Surgery, Feinberg School of Medicine, Northwestern University Chicago Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryan P.","family":"Merkow","sequence":"additional","affiliation":[{"name":"Department of Surgery and Center for Healthcare Studies Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine and Northwestern Medicine, Northwestern University Chicago Illinois"},{"name":"Department of Surgery Division of Breast Surgery, Feinberg School of Medicine, Northwestern University Chicago Illinois"},{"name":"Department of Surgery Massachusetts General Hospital Boston Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David P.","family":"Winchester","sequence":"additional","affiliation":[{"name":"The Cancer Programs, American College of Surgeons Chicago Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony D.","family":"Yang","sequence":"additional","affiliation":[{"name":"Northwestern Institute for Comparatives Effectiveness Research (NICER) in Oncology, Robert H. 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