title: Sentinel Lymph Node Frozen-Section Utilization Declines After Publication of American College of Surgeons Oncology Group Z0011 Trial Results With No Change in Subsequent Surgery for Axillary Lymph Node Dissection.
abstract: OBJECTIVE
  To evaluate use of sentinel lymph node (SLN) frozen section (FS) before and after publication of the Z0011 trial.
  
  
  METHODS
  We identified 116 pre-Z0011 and 134 post-Z0011 patients from 18 months before and after Z0011-initiated changes. Clinicopathologic features were assessed by chart review.
  
  
  RESULTS
  Post-Z0011 SLN FS use markedly declined when performed with breast-conserving therapy (BCT) (P < .0001), with SLN FS in 53 (73.6%) of 72 and 19 (25.0%) of 76 in pre- and post-Z0011 groups, respectively. There was post-Z0011 decline in axillary lymph node dissection (ALND) (P = .014) but no difference in later procedures for ALND. SLN positivity was associated with larger (≥1.6 cm) tumor size (P = .002). Nodal upstage was more frequent with invasive lobular (3/32; 9.4%) vs other invasive (2/188; 1.1%) subtypes.
  
  
  CONCLUSIONS
  Our findings support reduced need for SLN FS for BCT patients post-Z0011. However, those with specific clinicopathologic features may derive greater benefit from SLN FS.
authors.affiliation: From the Departments of Pathology jjorns@med.umich.edu.
authors.forename: Julie M
authors.initials: JM
authors.lastname: Jorns
authors.affiliation: Biostatistics, University of Michigan, Ann Arbor.
authors.forename: Kelley M
authors.initials: KM
authors.lastname: Kidwell
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology*; D005260:Female; D005629:Frozen Sections / Q000706:statistics & numerical data*; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000175:diagnosis*; D008875:Middle Aged; D021701:Sentinel Lymph Node Biopsy / Q000706:statistics & numerical data*
keywords: Breast cancer; Frozen section; Sentinel lymph node; Z0011