Background: Axillary lymph node evaluation (LND) is standard of care in the surgical management of invasive breast cancer, but benefit has not been demonstrated in ductal carcinoma in situ (DCIS). We aimed to determine the incidence of LND in women with DCIS undergoing breast conserving surgery (BCS) and mastectomy, and to identify clinical, hospital, and surgeon-related factors associated with LND. Methods: Perspectives database was used to identify women ages 18-90 with DCIS who underwent BCS or mastectomy between 2006-2012. Analyses were stratified by surgery type, and multivariable regression analysis was used to identify factors associated with LND. Results: Of 35,591 women identified with DCIS, 26,580 (74.7%) underwent BCS and 9,011 (25.3%) underwent mastectomy; 17.7% undergoing BCS and 63% undergoing mastectomy had LND. Rates increased over time with mastectomy (2006: 56.6%, 2012: 67.4%) and were relatively stable with BCS (2006: 18.5%, 2012: 16.2%). In a multivariable analysis, Medicaid insurance (RR 1.17, CI 1.05-1.30) and treatment in a non-teaching hospital (RR 1.13, CI 1.06-1.21) or urban location (RR 1.30, CI 1.09-1.55) were associated with LND with mastectomy. Among women undergoing BCS, Hispanic race (RR 1.32, CI 1.00-1.74) and treatment in a non-teaching hospital (RR 1.17, CI 1.03-1.33) influenced LND. Surgeon volume was the most significant predictor of LND with BCS (mid vs. low: RR 0.87, CI 0.70-0.94; high vs. low: RR 0.54, CI 0.44-0.65). Low volume surgeons performed LND in 26.4% of patients undergoing BCS, compared to 20.4% by mid volume and 10.4% by low volume surgeons. Conclusions: Despite guidelines recommending against LND in women with DCIS undergoing BCS and lack of evidence for its use with mastectomy, it is frequently performed. Given the additional morbidity and cost of these procedures, alternative surgical approaches or prospective evaluation of the clinical benefit of LND in women with DCIS is needed.