Department of Surgical Oncology, Brigham and Women's Hospital, Boston, MA.
Department of Breast Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX.
Clin Breast Cancer. 2018 Aug;18(4):276-281. doi: 10.1016/j.clbc.2017.10.007. Epub 2017 Oct 13.
After publication of American College of Surgeons Oncology Group (ACOSOG) Z0011, surgeons at our institution limited axillary surgery to sentinel lymph node dissection (SLND) in 76% of patients meeting trial eligibility criteria. Our study objective was to assess incorporation of the trial data into practice 5 years later.
Patients with clinical T1-2, N0 invasive breast cancer undergoing breast conserving surgery were included. Comparisons were made between patients who underwent axillary lymph node dissection (ALND) and those that had no further surgery.
A total of 396 patients were included. Twelve percent (48/396) had positive SLNs; ALND was performed in 8% (4/48). Patients who underwent ALND were more likely to have 2 positive SLNs (50%, 2/4 vs. 2%, 1/44; P = .02) and microscopic extranodal extension (75%, 3/4 vs. 18%, 8/44; P = .03) than those that did not undergo ALND. Patients who underwent ALND also had a higher nomogram-predicted probability of having additional positive non-SLNs (53%) than those who had SLND alone (22%) (P = .0002). No patients had intraoperative assessment of SLNs performed.
The practice of omitting ALND in ACOSOG Z0011-eligible patients has expanded over 5 years. Clinicopathologic features continue to impact this decision. Intraoperative SLN assessment is no longer performed.
在美国外科医师学院肿瘤学组(ACOSOG)Z0011 发表后,我们机构的外科医生将符合试验入选标准的 76%的患者的腋窝手术限制为前哨淋巴结清扫术(SLND)。我们的研究目的是评估 5 年后将试验数据纳入实践的情况。
纳入接受保乳手术的临床 T1-2、N0 浸润性乳腺癌患者。比较行腋窝淋巴结清扫术(ALND)和未进一步手术的患者。
共纳入 396 例患者。12%(48/396)的患者 SLN 阳性;ALND 手术在 8%(4/48)的患者中进行。行 ALND 的患者更有可能有 2 个阳性 SLN(50%,2/4 比 2%,1/44;P=.02)和显微镜下的淋巴结外扩展(75%,3/4 比 18%,8/44;P=.03),而非行 ALND 的患者。行 ALND 的患者的 nomogram 预测有额外阳性非 SLN 的概率也高于仅行 SLND 的患者(53%比 22%;P=0.0002)。没有患者进行 SLN 的术中评估。
在符合 ACOSOG Z0011 标准的患者中,省略 ALND 的做法在 5 年内得到了扩展。临床病理特征继续影响这一决定。术中 SLN 评估不再进行。