The current application of ACOSOG Z0011 trial results: Is further implementation of sentinel lymph node intra-operative histopathological examination mandatory in breast cancer patients – a single-center analysis

Abstract

The main objective of the ACOSOG Z0011 trial was to determine the impact of abandoning complete axillary lymph node dissection (ALND) on survival of breast cancer patients with sentinel node lymph (SLN) metastasis in whom breast conserving therapy (BCT) had been performed. The aim of our study was to assess the clinical value of intra-operative histopathological examination of SLN. Our study comprised 1284 invasive breast cancer patients in whom sentinel lymph node biopsy (SLNB) was carried out. SLN intra-operative histopathological assessment was routinely performed in patients treated within the first period (07.2013-06.2014). However, the decision regarding intra-operative assessment was made by the surgeon for the patients who underwent this evaluation in the later period 07.2014-06.2015 and were submitted for BCT. BCT was performed in 72.4% of patients. In total, 316 patients (24.6%) developed SLN-metastasis. Within the period 07.2014-06.2015, SLN intra-operative microscopic evaluation was performed in 20.8% of patients submitted for BCT. ALND was omitted in 27.5% of patients demonstrating SLN metastasis, in comparison with 15.5% of the group from the previous period (p=0.0094). The proportion of patients demonstrating macrometastasis in SLN who received conservative treatment to the axilla increased from 5.4% to 23.1% (p=0.0007). The choice of SLN final histopathological assessment may allow for deferral of decision on more extensive surgery of the axilla in patients submitted for SLNB. The omission of routinely-performed SLN intra-operative histopathological evaluation has led to a statistically significant increase in the proportion of patients in whom complete ALND was avoided.

Does the presence of sentinel lymph node macrometastases in breast cancer patients require axillary lymph node dissection?-Single-center analysis

“…Similar results were obtained in our study. After adopting current trends regarding managing SLN(+) patients with macrometastases, a decrease in completion ALND was observed (from 5.3% to 23.1%; P = .0007) …”

“…After adopting current trends regarding managing SLN(+) patients with macrometastases, a decrease in completion ALND was observed (from 5.3% to 23.1%; P = .0007). 17 A prospective analysis of conservative treatment outcomes in SLN (+) patients was also conducted in the IBCSG 23-01 (Galimberti et al) 8 and AATRM 048/13/2000 studies (Sola et al). 9 Contrary to the study by Giuliano et al, patients diagnosed with SLN micrometastases were enrolled in both studies.…”

Survival and recurrence with or without axillary dissection in patients with invasive breast cancer and sentinel node metastasis

“…The tendency towards reducing the use of intraoperative lymph node evaluation at our hospital following the publication of the ACOSOG Z0011 trial was similar to that in other studies 6,7,28,29 . Intraoperative assessment of the SLN can be associated with a shorter average time of surgery 6 , a reduction in perioperative costs 30,31 , and a significant increase in the proportion of patients in whom complete dissection can be avoided 32 . According to van der Noordaa et al, intraoperative assessments of the SLN should be performed only in patients with a restricted indication for lymph node dissection in the presence of metastasis in SLN biopsy 33 .…”

Implementation of the Findings from The American College of Surgeons Oncology Group Z0011 Study in Axillary Management in Patients with Invasive Breast Cancer: A Cohort Study in A Brazilian Public University Hospital

“…6,7,28,29 Intraoperative assessment of the sentinel lymph node can be associated with a shorter average time of surgery, 6 a reduction in perioperative costs, 30,31 and a signi cant increase in the proportion of patients in whom complete dissection can be avoided. 32 According to van der Noordaa et al, 33 intraoperative assessments of the sentinel lymph node should be performed only in patients with a restricted indication of lymph node dissection in the presence of metastasis in sentinel lymph node biopsy. Thus, the intraoperative assessment of the sentinel lymph node is not necessary for patients who meet the ACOSOG Z0011 criteria, and the surgical re-approach resulting from the de nitive anatomopathological result of the axilla is rare (3.8%).…”