Microscopic extracapsular extension in sentinel lymph nodes does not mandate axillary dissection in Z0011-eligible patients Journal Article


Authors: Barrio, A. V.; Downs-Canner, S.; Edelweiss, M.; Van Zee, K. J.; Cody, H. S. 3rd; Gemignani, M. L.; Pilewskie, M. L.; Plitas, G.; El-Tamer, M.; Kirstein, L.; Capko, D.; Patil, S.; Morrow, M.
Article Title: Microscopic extracapsular extension in sentinel lymph nodes does not mandate axillary dissection in Z0011-eligible patients
Abstract: Background: In the ACOSOG (American College of Surgeons Oncology Group) Z0011 trial and the AMAROS (After Mapping of the Axilla: Radiotherapy or Surgery?) trial, matted nodes with gross extracapsular extension (ECE), a risk factor for locoregional recurrence, were an indication for axillary lymph node dissection (ALND), but the effect of microscopic ECE (mECE) in the sentinel lymph nodes (SLNs) on recurrence was not examined. Methods: Between 2010 and 2017, 811 patients with cT1-2N0 breast cancer and SLN metastasis were prospectively managed according to Z0011 criteria, with ALND for those with more than two positive SLNs or gross ECE. Management of mECE was not specified. In this study, we compare outcomes of patients with one to two positive SLNs with and without mECE, treated with SLN biopsy alone (n = 685). Results: Median patient age was 58 years, and median tumor size was 1.7 cm. mECE was identified in 210 (31%) patients. Patients with mECE were older, had larger tumors, and were more likely to be hormone receptor positive and HER2 negative, have two positive SLNs, and receive nodal radiation. At a median follow-up of 41 months, no isolated axillary failures were observed. There were 11 nodal recurrences; two supraclavicular ± axillary, four synchronous with breast, and five with distant failure. The five-year rate of any nodal recurrence was 1.6% and did not differ by mECE (2.3% vs. 1.3%; p = 0.84). No differences were observed in local (p = 0.08) or distant (p = 0.31) recurrence rates by mECE status. Conclusions: In Z0011-eligible patients, nodal recurrence rates in patients with mECE are low after treatment with SLN biopsy alone, even in the absence of routine nodal radiation. The presence of mECE should not be considered a routine indication for ALND. © 2019, Society of Surgical Oncology.
Journal Title: Annals of Surgical Oncology
Volume: 27
Issue: 5
ISSN: 1068-9265
Publisher: Springer  
Date Published: 2020-05-01
Start Page: 1617
End Page: 1624
Language: English
DOI: 10.1245/s10434-019-08104-1
PUBMED: 31820212
PROVIDER: scopus
PMCID: PMC7145724
DOI/URL:
Notes: Article -- Source: Scopus
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MSK Authors
  1. Sujata Patil
    441 Patil
  2. Andrea Veronica Barrio
    52 Barrio
  3. Monica Morrow
    528 Morrow
  4. Deborah Capko
    12 Capko
  5. Kimberly J Van Zee
    261 Van Zee
  6. Hiram S Cody III
    224 Cody
  7. Mary L Gemignani
    164 Gemignani
  8. George Plitas
    61 Plitas