title: Measuring the impact of the American College of Surgeons Oncology Group Z0011 trial on breast cancer surgery in a community health system.
abstract: BACKGROUND
  The American College of Surgeons Oncology Group Z0011 trial has been lauded as practice changing. We sought to identify its impact on breast cancer surgery in the community hospital setting.
  
  
  METHODS
  A retrospective review was performed from 8 community hospitals identifying patients with invasive breast cancer meeting the Z0011 criteria. The primary outcome measures were the rate of completion axillary lymph node dissection (ALND) and performance of intraoperative sentinel lymph node (SLN) analysis over time.
  
  
  RESULTS
  A total of 1,125 lumpectomies with SLN biopsies were performed with 180 subjects meeting inclusion criteria. Performance of ALND (P < .0001) and intraoperative SLN analysis (P < .0001) declined during each time period. Patients more likely to undergo ALND included those with extracapsular extension (odds ratio [OR] 12.8, 95% confidence interval [CI] 2.5 to 67.1) and those who underwent reoperative surgery (OR 10.8, 95% CI 2.6 to 44.4) or intraoperative SLN analysis (OR 5.1, 95% CI 1.2 to 21.9).
  
  
  CONCLUSIONS
  American College of Surgeons Oncology Group Z0011 trial has been rapidly practice changing in the community hospital setting.
authors.affiliation: Grand Rapids Medical Education Partners, General Surgery Residency Program, Grand Rapids, MI, USA; Michigan State University College of Human Medicine, Grand Rapids, MI, USA. Electronic address: paul.wright@grmep.com.
authors.forename: Gerald Paul
authors.initials: GP
authors.lastname: Wright
authors.affiliation: Grand Rapids Medical Education Partners, General Surgery Residency Program, Grand Rapids, MI, USA; Michigan State University College of Human Medicine, Grand Rapids, MI, USA.
authors.forename: Megan E
authors.initials: ME
authors.lastname: Mater
authors.affiliation: Michigan State University College of Human Medicine, Grand Rapids, MI, USA.
authors.forename: Holly L
authors.initials: HL
authors.lastname: Sobel
authors.affiliation: Michigan State University College of Human Medicine, Grand Rapids, MI, USA; Grand Rapids Medical Education Partners, Plastic Surgery Residency Program, Grand Rapids, MI, USA.
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Knoll
authors.affiliation: Grand Rapids Medical Education Partners, General Surgery Residency Program, Grand Rapids, MI, USA; Michigan State University College of Human Medicine, Grand Rapids, MI, USA; Spectrum Health Medical Group, Division of Surgical Specialties, Grand Rapids, MI, USA.
authors.forename: Leon D
authors.initials: LD
authors.lastname: Oostendorp
authors.affiliation: Grand Rapids Medical Education Partners, General Surgery Residency Program, Grand Rapids, MI, USA; Michigan State University College of Human Medicine, Grand Rapids, MI, USA; Spectrum Health Medical Group, Division of Surgical Specialties, Grand Rapids, MI, USA.
authors.forename: Marianne K
authors.initials: MK
authors.lastname: Melnik
authors.affiliation: Grand Rapids Medical Education Partners, General Surgery Residency Program, Grand Rapids, MI, USA; Michigan State University College of Human Medicine, Grand Rapids, MI, USA; Spectrum Health Medical Group, Division of Surgical Specialties, Grand Rapids, MI, USA.
authors.forename: Mathew H
authors.initials: MH
authors.lastname: Chung
mesh_terms: D001365:Axilla; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D006764:Hospitals, Community; D006801:Humans; D008197:Lymph Node Excision; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D012955:Societies, Medical; D014481:United States
keywords: Axillary lymph node dissection; Breast cancer; Breast conserving surgery; Frozen section; Sentinel lymph node biopsy; Z11