Do the ACOSOG Z0011 criteria affect the number of sentinel lymph nodes removed? Journal Article


Authors: Subhedar, P.; Stempel, M.; Eaton, A.; Morrow, M.; Gemignani, M. L.
Article Title: Do the ACOSOG Z0011 criteria affect the number of sentinel lymph nodes removed?
Abstract: Introduction: We sought to determine if adoption of the Z0011 criteria was associated with removal of more sentinel lymph nodes (SLNs). Methods: In a retrospective review of a prospective database of breast cancer patients treated at our institution from 2006 to 2013, we identified 5213 eligible patients who elected to undergo breast-conserving surgery; 2372 were treated pre-Z0011 and 2841 post-Z0011. Clinicopathologic factors were collected, and univariate and multivariate models were fit to identify variables associated with number of SLNs removed. Results: Median patient age, 60 years, did not differ between groups. Median tumor size was similar in both groups: 1.1 (0.05–5.0) cm in the pre-Z0011 group and 1.2 (0.1–5.2) cm in the post-Z0011 group. The mean number of SLNs excised in the pre-Z0011 patients was 2.8 compared with 2.9 in post-Z0011 patients (p = 0.01). Three or fewer lymph nodes were removed in 1771 (75 %) pre-Z0011 patients compared with 2006 (71 %) post-Z0011 patients (p = 0.01). Factors associated with the removal of more SLNs on multivariate analysis included adoption of ACOSOG Z0011 criteria (p = 0.03), young age (p ≤ 0.0001), and large tumor size (p = 0.0005). Axillary lymph node dissection (ALND) was performed in 379 (16 %) patients pre-Z0011 compared with 68 (2 %) node-positive post-Z0011 patients (p < 0.0001). Conclusions: Since the adoption of Z0011 criteria, we found significantly fewer patients undergoing ALND for positive SLNs. We noted a significant, slight shift in the removal of ≥4 SLNs. The Z0011 criteria were not associated with a clinically significant increase in the number of SLNs removed. © 2015, Society of Surgical Oncology.
Keywords: adult; aged; major clinical study; histopathology; lymph node dissection; sentinel lymph node; breast cancer; epidermal growth factor receptor 2; retrospective study; age; axillary lymph node; cancer size; partial mastectomy; cancer classification; estrogen receptor; progesterone receptor; intraductal carcinoma; lymph vessel metastasis; human; female; article; acosog z011 criteria
Journal Title: Annals of Surgical Oncology
Volume: 22
Issue: Suppl. 3
ISSN: 1068-9265
Publisher: Springer  
Date Published: 2015-12-01
Start Page: 470
End Page: 475
Language: English
DOI: 10.1245/s10434-015-4698-6
PROVIDER: scopus
PMCID: PMC4688213
PUBMED: 26178759
DOI/URL:
Notes: Article -- Export Date: 3 February 2016 -- Source: Scopus
Altmetric
Citation Impact
MSK Authors
  1. Monica Morrow
    629 Morrow
  2. Mary L Gemignani
    190 Gemignani
  3. Anne Austin Eaton
    122 Eaton
  4. Michelle Moccio Stempel
    153 Stempel