Omission of intraoperative frozen section may reduce axillary overtreatment among clinically node-negative patients having upfront mastectomy Journal Article
| Authors: | Williams, A. D.; Khan, A. J.; Sevilimedu, V.; Barrio, A. V.; Morrow, M.; Mamtani, A. |
| Article Title: | Omission of intraoperative frozen section may reduce axillary overtreatment among clinically node-negative patients having upfront mastectomy |
| Abstract: | Background: The growing use of postmastectomy radiation/regional nodal irradiation (PMRT) has resulted in many women receiving both axillary dissection (ALND) and PMRT, increasing lymphedema rates. After developing standardized PMRT criteria, we adopted a policy of ALND omission among cN0 patients with 1–2 positive sentinel nodes (+SLNs) requiring PMRT. We evaluated how often overtreatment with ALND+PMRT was avoided with this approach. Methods: A retrospective review of a prospectively maintained database was performed beginning 1 year before policy adoption. Intraoperative SLN evaluation was routine pre- and post-policy. ALND was performed for SLN macrometastasis pre-policy, and selectively performed post-policy for 1–2 +SLNs based on PMRT criteria. ALND+PMRT was required for ≥ 3 +SLNs. Results: From March 1, 2018 to November 30, 2020, a total of 2207 cT1-3N0 patients had mastectomy and 231 had +SLNs; 109 (47%) were treated pre-policy and 122 (53%) post-policy. Most (81%) had 1–2 +SLNs. There was no change in rates of ALND+PMRT (64% pre-policy vs. 58% post-policy, p = 0.09), including in patients with 1–2 +SLNs (61% vs. 51%, p = 0.20). Post-policy, ALND was omitted in 9 (7%) patients recognized intraoperatively as PMRT candidates; avoidable ALND was performed in 40 (33%) patients not identified as PMRT candidates until receipt of final pathology. Overall, had intraoperative SLN evaluation been deferred, only 5.7% of patients would have required completion ALND: 2.2% (n = 49/2207) for ≥ 3 +SLNs and 3.5% (n = 77/2207) for 1–2 +SLNs without PMRT indication. Conclusions: Most patients could have avoided ALND+PMRT if decision making was deferred until final pathology was available. Selective intraoperative SLN evaluation in cN0 patients having upfront mastectomy may reduce avoidable overtreatment. © 2022, Society of Surgical Oncology. |
| Keywords: | adult; major clinical study; lymph node metastasis; lymph node dissection; lymphatic metastasis; prospective study; sentinel lymph node; lymph node excision; sentinel lymph node biopsy; mastectomy; breast neoplasms; retrospective study; breast tumor; clinical evaluation; irradiation; axilla; decision making; frozen section; frozen sections; axillary lymph node dissection; adoption; humans; human; male; female; article; overtreatment |
| Journal Title: | Annals of Surgical Oncology |
| Volume: | 29 |
| Issue: | 13 |
| ISSN: | 1068-9265 |
| Publisher: | Springer |
| Date Published: | 2022-12-01 |
| Start Page: | 8037 |
| End Page: | 8043 |
| Language: | English |
| DOI: | 10.1245/s10434-022-12238-0 |
| PUBMED: | 35951137 |
| PROVIDER: | scopus |
| PMCID: | PMC10321553 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 December 2022 -- Source: Scopus |
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