Which patients with sentinel node-positive breast cancer after breast conservation still receive completion axillary lymph node dissection in routine clinical practice?

Hennigs, André; Köpke, Melitta; Feißt, Manuel; Riedel, Fabian; Rezai, Mahdi; Nitz, Ulrike; Moderow, Mareike; Golatta, Michael; Sohn, Christof; Schneeweiß, Andreas; Heil, Jörg

doi:10.1007/s10549-018-5009-2

Cited by 24 publications

(19 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Clinical adoption of clinical trial findings that are counter to previously held standards has been demonstrated to be a slow process 7–9 . Given the publication of these practice‐changing clinical trials, we sought to assess surgeons’ awareness of the MSLT‐II findings, in particular, and its impact on CLND recommendations in their practices.…”

Section: Introductionmentioning

confidence: 99%

“…Clinical adoption of clinical trial findings that are counter to previously held standards has been demonstrated to be a slow process. [7][8][9] Given the publication of these practice-changing clinical trials, we sought to assess surgeons' awareness of the MSLT-II findings, in particular, and its impact on CLND recommendations in their practices. Seven patient scenarios were presented (see Table S1), and surgeons were asked about their likelihood of recommending a CLND (axillary and superficial inguinal).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Surgeon decision‐making for management of positive sentinel lymph nodes in the post‐Multicenter Selective Lymphadenectomy Trial II era: A survey study

Hui

Burke

Broman

et al. 2020

Journal of Surgical Oncology

View full text Add to dashboard Cite

Background and ObjectivesCompletion lymph node dissection (CLND) did not improve melanoma‐specific survival for patients with sentinel lymph node (SLN)‐positive melanoma in the second Multicenter Selective Lymphadenectomy Trial (MSLT‐II). We assessed surgeons’ awareness of MSLT‐II and its impact on CLND recommendations.MethodsAn anonymous online cross‐sectional survey of the Society of Surgical Oncology membership evaluated surgeon thresholds in offering CLND using patient scenarios and clinicopathologic characteristics ranking.ResultsOf the 2881 e‐mails delivered, 146 surgeons (5.1%) completed all seven scenarios. Most (129 of 131, 98%) were aware of MSLT‐II and 125 (95%) found it practice‐changing. Specifically, 52% (65 of 125) always, 40% usually, 6% rarely, and 3% never offered CLND before MSLT‐II. Meanwhile, 4% always, 9% usually, 78% rarely, and 8% never offer CLND now, after MSLT‐II (p < .0001). The most important clinicopathologic factors in determining CLND recommendations were extracapsular extension, number of positive SLN, and SLN tumor deposit size, while primary tumor mitotic index and nodal basin location were the least important. Surgical oncology fellowship training, melanoma patient volume, and academic center practice also influenced CLND recommendations.ConclusionsMost surgeon respondents are aware of MSLT‐II, but its application in practice varies according to several clinicopathologic and surgeon factors.

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Surgeon decision‐making for management of positive sentinel lymph nodes in the post‐Multicenter Selective Lymphadenectomy Trial II era: A survey study

Hui

Burke

Broman

et al. 2020

Journal of Surgical Oncology

View full text Add to dashboard Cite

show abstract

“…Unlike in the ACOSOG Z0011 trial, all analyses for this study were made using the pathological tumor stage (pT) due to the inconsistent documentation of the clinical tumor (cT) stage in our database. This substitution seems reasonable, given the high concordance between the two types of staging [16]. All participating institutes that provided patient data to the database were labeled before the beginning of the analysis either as university hospitals, academic hospitals (i.e.…”

Section: Eligibility Criteriamentioning

confidence: 99%

“…The results from the ACOSOG trial have been incorporated into guidelines [15] and the clinical routine [3,16], but surgeon acceptance still underlies high variability [17]. On the other hand, clinical practice based on the ACOSOG Z0011 results has the advantages of reducing morbidity [18] and healthcare costs [19].…”

Section: Introductionmentioning

confidence: 99%

Analyzing non-sentinel axillary metastases in patients with T3–T4 cN0 early breast cancer and tumor-involved sentinel lymph nodes undergoing breast-conserving therapy or mastectomy

Riedel

Heil

Feißt

et al. 2020

Breast Cancer Res Treat

Self Cite

View full text Add to dashboard Cite

Purpose In the ACOSOG Z0011 trial, completing axillary lymph node dissection (cALND) did not benefit patients with T1–T2 cN0 early breast cancer and 1–2 positive sentinel lymph nodes (SLN) undergoing breast-conserving surgery (BCT). This paper reports cALND rates in the clinical routine for patients who had higher (T3–T4) tumor stages and/or underwent mastectomy but otherwise met the ACOSOG Z0011 eligibility criteria. Aim of this study is to determine cALND time trends and non-sentinel axillary metastases (NSAM) rates to estimate occult axillary tumor burden. Methods Data were included from patients treated in 179 German breast cancer centers between 2008 and 2015. Time-trend rates were analyzed for cALND of patients with T3–T4 tumors separated for BCT and mastectomy and regarding presence of axillary macrometastases or micrometastases. Results Data were available for 188,909 patients, of whom 19,009 were identified with 1–2 positive SLN. Those 19,009 patients were separated into 4 cohorts: (1) Patients with T1–T2 tumors receiving BCT (ACOSOG Z0011 eligible; n = 13,741), (2) T1–T2 with mastectomy (n = 4093), (3) T3–T4 with BCT (n = 269), (4) T3–T4 with mastectomy (n = 906). Among patients with T3–T4 tumors, cALND rates declined from 2008 to 2015: from 88.2 to 62.6% for patients receiving mastectomy and from 96.6 to 58.1% in patients receiving BCT. Overall rates for any NSAM after cALND for cohorts 1–4 were 33.4%, 42.3%, 46.9%, 58.8%, respectively. Conclusions The cALND rates have decreased substantially in routine care in patients with ‘extended’ ACOSOG Z0011 eligibility criteria. Axillary tumor burden is higher in these patients than in the ACOSOG Z0011 trial.

show abstract

“…Dear Editor, I want to congratulate Hennigs and their colleagues for their article [1] in which they investigated which patients with sentinel lymph node (SLNs)-positive breast cancer after breast conservation still received completion axillary lymph node dissection (cALND) in routine clinical practice. They reported that fewer removed SLNs, two tumouraffected SLNs, younger age, lower annual case volume per hospital, higher tumour grade, and lymphovascular invasion were associated with cALND.…”

mentioning

confidence: 99%

Extranodular extension in sentinel lymph node-positive breast cancer might predict further initiation of completion axillary lymph node dissection

Altundağ

2018

Breast Cancer Res Treat

View full text Add to dashboard Cite

Which patients with sentinel node-positive breast cancer after breast conservation still receive completion axillary lymph node dissection in routine clinical practice?

Cited by 24 publications

References 24 publications

Surgeon decision‐making for management of positive sentinel lymph nodes in the post‐Multicenter Selective Lymphadenectomy Trial II era: A survey study

Surgeon decision‐making for management of positive sentinel lymph nodes in the post‐Multicenter Selective Lymphadenectomy Trial II era: A survey study

Analyzing non-sentinel axillary metastases in patients with T3–T4 cN0 early breast cancer and tumor-involved sentinel lymph nodes undergoing breast-conserving therapy or mastectomy

Extranodular extension in sentinel lymph node-positive breast cancer might predict further initiation of completion axillary lymph node dissection

Contact Info

Product

Resources

About