title: Impact of American College of Surgeons Oncology Group Z0011 and National Surgical Adjuvant Breast and Bowel Project B-32 trial results on surgeon practice in the Pacific Northwest.
abstract: BACKGROUND
  Recent clinical trials have suggested no survival benefit for completion axillary node dissection (CALND) after sentinel lymph node biopsy (American College of Surgeons Oncology Group Z0011) and no clinically meaningful benefit for the routine use of immunohistochemistry (National Surgical Adjuvant Breast and Bowel Project B-32) in clinically node-negative breast cancer.
  
  
  METHODS
  A 12-question electronic survey was distributed to members of 3 Pacific Northwest surgical societies. Surgeons were queried regarding the impact of the trial results on their surgical management of breast cancer.
  
  
  RESULTS
  The 181 respondents reported performing fewer CALNDs (63%), fewer intraoperative frozen sections (21%), and no immunohistochemistry (12%) because of trial data. However, 28% of surgeons continued to perform CALND in patients with 1 to 2 positive sentinel lymph nodes undergoing lumpectomy and postoperative radiation.
  
  
  CONCLUSIONS
  Recent trial data have impacted the performance of CALNDs and the pathological evaluation of sentinel lymph nodes among Pacific Northwest surgeons. Our results suggest a need for regional surgical societies to disseminate practice-changing trial data to members.
authors.affiliation: Division of General Surgery, Department of Surgery, Oregon Health and Science University, Portland, OR, USA.
authors.forename: Kristen P
authors.initials: KP
authors.lastname: Massimino
authors.affiliation: Division of General Surgery, Department of Surgery, Oregon Health and Science University, Portland, OR, USA.
authors.forename: Crystal J
authors.initials: CJ
authors.lastname: Hessman
authors.affiliation: Division of General Surgery, Department of Surgery, Oregon Health and Science University, Portland, OR, USA.
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Ellis
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, L619, Portland, OR 97239, USA.
authors.forename: Arpana M
authors.initials: AM
authors.lastname: Naik
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, L619, Portland, OR 97239, USA. Electronic address: vettoj@ohsu.edu.
authors.forename: John T
authors.initials: JT
authors.lastname: Vetto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000601:surgery*; D002986:Clinical Trials as Topic; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D015205:Northwestern United States; D010818:Practice Patterns, Physicians'; D012955:Societies, Medical; D011795:Surveys and Questionnaires