Axillary dissection versus no axillary dissection in women with invasive breast cancer and sentinel node metastasis

Latosinsky, Steve; Berrang, Tanya; Cutter, Calvin; George, Ralph; Olivotto, Ivo A.; Julian, Thomas B.; Hayashi, Allen; Baliski, Christopher; Croshaw, Randall; Erb, Kathleen M.; Chen, Jennifer

doi:10.1503/cjs.036011

Cited by 38 publications

(19 citation statements)

References 11 publications

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“…This results in less need for routine preoperative axillary staging (37). However, there are serious concerns about the rapid implementation of these results into clinical practice regarding the study's methodologic problems that lead to difficulties with analysis, interpretation, and confidence in the results (38)(39)(40). A different interpretation of this data has even led to a challenge of the SLNB concept and the emergence of a new study in which patients are randomized to undergo SLNB with or without ALND or to no axillary surgery arms, depending on negative US or FNAB assessments (41).…”

Section: Discussionmentioning

confidence: 99%

Axillary Lymph Node Biopsy in Newly Diagnosed Invasive Breast Cancer: Comparative Accuracy of Fine-Needle Aspiration Biopsy versus Core-Needle Biopsy

Rautiainen¹,

Masarwah²,

Sudah³

et al. 2013

Radiology

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Section: Discussionmentioning

confidence: 99%

Axillary Lymph Node Biopsy in Newly Diagnosed Invasive Breast Cancer: Comparative Accuracy of Fine-Needle Aspiration Biopsy versus Core-Needle Biopsy

Rautiainen¹,

Masarwah²,

Sudah³

et al. 2013

Radiology

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“…However, the methodology of the Z0011 trial has been criticized. 14 The trial was closed early with less than 50% target accrual, possibly due to clinician bias towards standard axillary lymph node dissection. There was also a high survival and low event rate (only 92 events for the trial), and a large number of women in both groups were lost to follow-up -21% in the axillary dissection group and 17% in the SLNB group.…”

Section: Discussionmentioning

confidence: 99%

Relevance of the American College of Surgeons Oncology Group Z0011 Trial to breast cancer in the Australian setting

et al. 2013

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Background: Conventional wisdom suggests that a patient with a positive sentinel node requires a completion axillary clearance to obtain full staging and durable regional control. However, this dictum has been challenged by the recent American College of Surgeons Oncology Group Z0011 Trial demonstrating that women with node-positive breast cancer who underwent sentinel node biopsy only, and were treated with breast conserving surgery and radiation, had equivalent locoregional recurrence and survival rates to those who had a completion axillary clearance. The aim of our study was to determine what the clinical impact of the Z0011 findings might be if patients were managed according to the Z0011 criteria in an Australian teaching hospital setting. Methods: We performed a retrospective review, using prospectively collected data, of all female patients with breast cancer assessed at the Westmead Breast Cancer Institute in 2010 and identified the subgroup who would potentially have fulfilled all Z0011 criteria. The characteristics and management of this group were compared with nodepositive and to mastectomy patient subgroups. Results: A total of 280 patients with invasive breast cancer were identified. Twentysix patients satisfied all Z0011 criteria, representing 9.3% of all patients and 21.5% of node-positive patients. Twenty-two (84.6%) patients had a subsequent axillary clearance, with six (27.3%) having additional positive nodes. Conclusions: The Z0011 study is relevant to 9.3% of all breast cancer patients and 21.5% of node-positive breast cancer patients treated in a major Australian teaching hospital.

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“…Completion ALND is no longer recommended (only '+/-' grade of recommendation) in patients with positive sentinel nodes and in case of: cT1/2, cN0, less than 3 sentinel nodes involved, BCS plus tangential breast irradiation, no alternative ART, and adequate systemic therapy [23]. Although these results seem somewhat definitive and provide strong support for the abandonment of ALND for 'Z0011-eligible' patients, there are several concerns regarding the design, accrual, and data collection (details in [6,61]). …”

Section: Radiotherapy For Involved Slnmentioning

confidence: 99%

Local Treatment of the Axilla in Early Breast Cancer: Concepts from the National Surgical Adjuvant Breast and Bowel Project B-04 to the Planned Intergroup Sentinel Mamma Trial

et al. 2014

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Local treatment of the axilla in clinically node-negative, early-stage breast cancer patients has been hotly debated after the release of the American College of Surgeons Oncology Group (ACOSOG) Z0011 findings. However, this review does not focus on the ‘Z0011-eligible' patients alone, because this subgroup represents a minority of our patients undergoing breast-conserving surgery (BCS) and sentinel lymph node biopsy (SLNB). The following topics are discussed: axillary diagnostics, timing of axillary procedures in the neoadjuvant setting, long-term follow-up of SLNB trials, omission of axillary surgery in randomized trials, management of the involved axilla with low tumor volume, positive sentinel lymph nodes and BCS, involved sentinel lymph nodes and mastectomy, and axillary radiotherapy. Finally, the current innovative study concepts (i.e. Sentinel Node versus Observation after Axillary Ultrasound (SOUND) and Intergroup Sentinel Mamma (INSEMA)) including patients with axillary observation alone in clinically node-negative women are presented.

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Axillary dissection versus no axillary dissection in women with invasive breast cancer and sentinel node metastasis

Cited by 38 publications

References 11 publications

Axillary Lymph Node Biopsy in Newly Diagnosed Invasive Breast Cancer: Comparative Accuracy of Fine-Needle Aspiration Biopsy versus Core-Needle Biopsy

Axillary Lymph Node Biopsy in Newly Diagnosed Invasive Breast Cancer: Comparative Accuracy of Fine-Needle Aspiration Biopsy versus Core-Needle Biopsy

Relevance of the American College of Surgeons Oncology Group Z0011 Trial to breast cancer in the Australian setting

Local Treatment of the Axilla in Early Breast Cancer: Concepts from the National Surgical Adjuvant Breast and Bowel Project B-04 to the Planned Intergroup Sentinel Mamma Trial

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