title: Axillary dissection can be avoided in the majority of clinically node-negative patients undergoing breast-conserving therapy.
abstract: BACKGROUND
  The extent to which ACOSOG Z0011 findings are applicable to patients undergoing breast-conserving therapy (BCT) is uncertain. We prospectively assessed how often axillary dissection (ALND) was avoided in an unselected, consecutive patient cohort meeting Z0011 eligibility criteria and whether subgroups requiring ALND could be identified preoperatively.
  
  
  METHODS
  Patients with cT1,2cN0 breast cancer undergoing BCT were managed without ALND for metastases in <3 sentinel nodes (SNs) and no gross extracapsular extension (ECE). Patients with and without indications for ALND were compared using Fisher's exact and Wilcoxon rank sum tests.
  
  
  RESULTS
  From August 2010 to November 2012, 2,157 invasive cancer patients had BCT. A total of 380 had histologic nodal metastasis; 93 did not meet Z0011 criteria. Of 287 with ≥1 H&E-positive SN (209 macrometastases), 242 (84 %) had indications for SN only. ALND was indicated in 45 for ≥3 positive SNs (n = 29) or ECE (n = 16). The median number of SNs removed in the SN group was 3 versus 5 in the ALND group (p < 0.0001). Age, hormone receptor and HER2 status, and grade did not differ between groups; tumors were larger in the ALND group (p < 0.0001). Of ALND patients, 72 % had additional positive nodes (median = 1; range 1-19). No axillary recurrences have occurred (median follow-up, 13 months).
  
  
  CONCLUSIONS
  ALND was avoided in 84 % of a consecutive series of patients having BCT, suggesting that most patients meeting ACOSOG Z0011 eligibility have a low axillary tumor burden. Age, ER, and HER2 status were not predictive of ALND, and the criteria used for ALND (≥3 SNs, ECE) reliably identified patients at high risk for residual axillary disease.
authors: Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, USA.
authors: Lynn T
authors: LT
authors: Dengel
authors: Kimberly J
authors: KJ
authors: Van Zee
authors: Tari A
authors: TA
authors: King
authors: Michelle
authors: M
authors: Stempel
authors: Hiram S
authors: HS
authors: Cody
authors: Mahmoud
authors: M
authors: El-Tamer
authors: Mary L
authors: ML
authors: Gemignani
authors: Lisa M
authors: LM
authors: Sclafani
authors: Virgilio S
authors: VS
authors: Sacchini
authors: Alexandra S
authors: AS
authors: Heerdt
authors: George
authors: G
authors: Plitas
authors: Manuela
authors: M
authors: Junqueira
authors: Deborah
authors: D
authors: Capko
authors: Sujata
authors: S
authors: Patil
authors: Monica
authors: M
authors: Morrow
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D021701:Sentinel Lymph Node Biopsy
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