Axillary dissection can be avoided in the majority of clinically node-negative patients undergoing breast-conserving therapy Journal Article

Authors: Dengel, L. T.; Van Zee, K. J.; King, T. A.; Stempel, M.; Cody, H. S.; El-Tamer, M.; Gemignani, M. L.; Sclafani, L. M.; Sacchini, V. S.; Heerdt, A. S.; Plitas, G.; Junqueira, M.; Capko, D.; Patil, S.; Morrow, M.
Article Title: Axillary dissection can be avoided in the majority of clinically node-negative patients undergoing breast-conserving therapy
Abstract: Abstract: Background: The extent to which ACOSOG Z0011 findings are applicable to patients undergoing breast-conserving therapy (BCT) is uncertain. We prospectively assessed how often axillary dissection (ALND) was avoided in an unselected, consecutive patient cohort meeting Z0011 eligibility criteria and whether subgroups requiring ALND could be identified preoperatively. Methods: Patients with cT1,2cN0 breast cancer undergoing BCT were managed without ALND for metastases in <3 sentinel nodes (SNs) and no gross extracapsular extension (ECE). Patients with and without indications for ALND were compared using Fisher's exact and Wilcoxon rank sum tests. Results: From August 2010 to November 2012, 2,157 invasive cancer patients had BCT. A total of 380 had histologic nodal metastasis; 93 did not meet Z0011 criteria. Of 287 with ≥1 H&E-positive SN (209 macrometastases), 242 (84 %) had indications for SN only. ALND was indicated in 45 for ≥3 positive SNs (n = 29) or ECE (n = 16). The median number of SNs removed in the SN group was 3 versus 5 in the ALND group (p < 0.0001). Age, hormone receptor and HER2 status, and grade did not differ between groups; tumors were larger in the ALND group (p < 0.0001). Of ALND patients, 72 % had additional positive nodes (median = 1; range 1-19). No axillary recurrences have occurred (median follow-up, 13 months). Conclusions: ALND was avoided in 84 % of a consecutive series of patients having BCT, suggesting that most patients meeting ACOSOG Z0011 eligibility have a low axillary tumor burden. Age, ER, and HER2 status were not predictive of ALND, and the criteria used for ALND (≥3 SNs, ECE) reliably identified patients at high risk for residual axillary disease. © 2013 Society of Surgical Oncology.
Journal Title: Annals of Surgical Oncology
Volume: 21
Issue: 1
ISSN: 1068-9265
Publisher: Springer  
Date Published: 2014-01-01
Start Page: 22
End Page: 27
Language: English
DOI: 10.1245/s10434-013-3200-6
PROVIDER: scopus
PUBMED: 23975314
PMCID: PMC4349525
Notes: Export Date: 3 February 2014 -- CODEN: ASONF -- Source: Scopus
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MSK Authors
  1. Sujata Patil
    390 Patil
  2. Monica Morrow
    458 Morrow
  3. Deborah Capko
    10 Capko
  4. Kimberly J Van Zee
    243 Van Zee
  5. Hiram S Cody III
    210 Cody
  6. Mary L Gemignani
    147 Gemignani
  7. Tari King
    167 King
  8. Alexandra S Heerdt
    86 Heerdt
  9. George Plitas
    53 Plitas
  10. Michelle Moccio Stempel
    135 Stempel