title: The impact of the American College of Surgeons Oncology Group (ACOSOG) Z0011 trial: An institutional review.
abstract: BACKGROUND
  Axillary dissection (AD) was historically recommended for all patients with breast tumor involvement discovered by sentinel lymph node biopsy (+SLNB). However, after the ACOSOG Z0011 trial, omission of AD became the recommendation for selected patients with a +SLNB. We report the impact of ACOSOG Z0011 on the completion AD rate in patients with +SLNB at our institution.
  
  
  METHODS
  We retrospectively reviewed all patients diagnosed with breast cancer between March 2009 and February 2013 (n = 1781). This cohort was divided into two groups: 1) those diagnosed BEFORE Z0011 and 2) those diagnosed AFTER Z0011. We calculated both the percentage of patients with a +SNLB who underwent AD and, from those patients, the percentage who did and did not meet the Z0011 criteria.
  
  
  RESULTS
  The BEFORE group contained 849 patients; 144 had +SLNB and from those 113 underwent AD. The AFTER group contained 932 patients: 139 had +SLNB and from those 73 underwent AD. The completion AD rate in the BEFORE group was 78.5%, compared to 52.5% in the AFTER group (p < 0.001). From the patients who met the Z0011 criteria, 75.6% of the BEFORE patients underwent AD, compared to only 2.2%% in the AFTER group (p < 0.001). Among those who did not meet the Z0011 criteria, a similar percentage of patients underwent AD in each group (BEFORE 79.8%, AFTER 74.4%, p = 0.384).
  
  
  CONCLUSIONS
  Following the publication of the ACOSOG Z0011 trial, we experienced a significant decrease in the completion AD rate among patients with a +SLNB who met the Z0011 inclusion criteria.
authors.affiliation: Department of Surgery, Division of Surgical Oncology, Greenville Health System, Greenville, SC, USA. Electronic address: VLe@ghs.org.
authors.forename: Viet H
authors.initials: VH
authors.lastname: Le
authors.affiliation: Department of Surgery, Division of Surgical Oncology, Greenville Health System, Greenville, SC, USA.
authors.forename: Kathleen N
authors.initials: KN
authors.lastname: Brant
authors.affiliation: Department of Surgery, Division of Surgical Oncology, Greenville Health System, Greenville, SC, USA.
authors.forename: Dawn W
authors.initials: DW
authors.lastname: Blackhurst
authors.affiliation: Department of Pathology, Greenville Health System, Greenville, SC, USA.
authors.forename: Christine M G
authors.initials: CM
authors.lastname: Schammel
authors.affiliation: Department of Pathology, Greenville Health System, Greenville, SC, USA.
authors.forename: David P
authors.initials: DP
authors.lastname: Schammel
authors.affiliation: Department of Surgery, Division of Surgical Oncology, Greenville Health System, Greenville, SC, USA.
authors.forename: Wendy R
authors.initials: WR
authors.lastname: Cornett
authors.affiliation: Department of Surgery, Division of Surgical Oncology, Greenville Health System, Greenville, SC, USA.
authors.forename: Brian P
authors.initials: BP
authors.lastname: McKinley
mesh_terms: D000368:Aged; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D002986:Clinical Trials as Topic; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000592:standards / Q000706:statistics & numerical data*; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy
keywords: ACOSOG Z0011 trial; Axillary lymph node dissection; Sentinel lymph node biopsy