Expanding Implementation of ACOSOG Z0011 in Surgeon Practice. Academic Article uri icon

Overview

abstract

  • BACKGROUND: After publication of American College of Surgeons Oncology Group (ACOSOG) Z0011, surgeons at our institution limited axillary surgery to sentinel lymph node dissection (SLND) in 76% of patients meeting trial eligibility criteria. Our study objective was to assess incorporation of the trial data into practice 5 years later. PATIENTS AND METHODS: Patients with clinical T1-2, N0 invasive breast cancer undergoing breast conserving surgery were included. Comparisons were made between patients who underwent axillary lymph node dissection (ALND) and those that had no further surgery. RESULTS: A total of 396 patients were included. Twelve percent (48/396) had positive SLNs; ALND was performed in 8% (4/48). Patients who underwent ALND were more likely to have 2 positive SLNs (50%, 2/4 vs. 2%, 1/44; P = .02) and microscopic extranodal extension (75%, 3/4 vs. 18%, 8/44; P = .03) than those that did not undergo ALND. Patients who underwent ALND also had a higher nomogram-predicted probability of having additional positive non-SLNs (53%) than those who had SLND alone (22%) (P = .0002). No patients had intraoperative assessment of SLNs performed. CONCLUSIONS: The practice of omitting ALND in ACOSOG Z0011-eligible patients has expanded over 5 years. Clinicopathologic features continue to impact this decision. Intraoperative SLN assessment is no longer performed.

publication date

  • October 13, 2017

Research

keywords

  • Breast Neoplasms
  • Lymph Node Excision
  • Lymph Nodes
  • Medical Oncology
  • Practice Patterns, Physicians'

Identity

PubMed Central ID

  • PMC5899057

Scopus Document Identifier

  • 85032990199

Digital Object Identifier (DOI)

  • 10.1016/j.jamcollsurg.2013.01.064

PubMed ID

  • 29100726

Additional Document Info

volume

  • 18

issue

  • 4