• Anna Weiss, Elizabeth A Mittendorf, Sarah M DeSnyder, Rosa F Hwang, Vivian Bea, Isabelle Bedrosian, Karen Hoffman, Beatriz Adrade, Aysegul A Sahin, Henry M Kuerer, Kelly K Hunt, and Abigail S Caudle.
• Department of Surgical Oncology, Brigham and Women's Hospital, Boston, MA.
• Clin. Breast Cancer. 2018 Aug 1; 18 (4): 276-281.

BackgroundAfter 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 MethodsPatients 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.ResultsA 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.ConclusionsThe 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.Copyright © 2017 Elsevier Inc. All rights reserved.

35 keywords...

hide…