Millen Eduardo Camargo, Cavalcante Francisco Pimentel, Zerwes Felipe, Novita Guilherme, de Souza Alessandra Borba Anton, Reis João Henrique Penna, de Oliveira Filho Helio Rubens, de B L Limongi Luciana Naíra, de Assis Carvalho Barbara Pace Silva, de Oliveira Freitas Adriana Magalhães, Jourdan Monica Travassos, de Oliveira Vilmar Marques, Freitas-Junior Ruffo
Breast Unit, Leblon Medical Center, Rio de Janeiro, Brazil.
Breast Unit, Fortaleza General Hospital (HGF), Fortaleza, Brazil.
Ann Surg Oncol. 2022 Feb;29(2):1087-1095. doi: 10.1245/s10434-021-10812-6. Epub 2021 Sep 27.
To evaluate the impact of the ACOSOG Z0011 trial on axillary breast cancer surgery management in Brazil following publication of that study (2010) and again in 2020.
A survey of members of the Brazilian Society of Mastology.
Of 1627 breast surgeons, 799 (49.1%) completed and returned the questionnaire. For patients with the Z11 inclusion criteria, following detection of a positive sentinel lymph node (SLN), axillary dissection (AD) was recommended by 99.2% of respondents before publication of the study, 47.5% in 2010 and 18.5% in 2020 (p < 0.001). In breast-conserving surgery, if there were micro-metastases, 2.6% would perform AD, 30.3% axillary radiotherapy, and 67.1% no additional axillary treatment, while with macro-metastases, these proportions were 21.3%, 52.2%, and 26.5%, respectively. In cases of mastectomy and of nodal extracapsular extension, 43.4% and 36% of surgeons, respectively, recommended AD. For clinically negative axilla and suspicious findings at ultrasonography, 69% of the surgeons would apply the Z11 approach. Most applied the Z11 criteria in cases of younger patients (83.6%) and triple-negative and/or HER2 positive tumors (74%). AD was significantly more likely to be recommended by surgeons who did not work in academic institutes, who worked in locations other than capital cities, who were not board-certified, and who were ≥ 50 years old.
This survey revealed substantial changes in axillary surgery management in cN0/pathologically positive SLN, particularly following publication of the updated Z11 results and other similar studies. A better education environment and long-term follow-up were factors associated with the incorporation of Z11-related changes in practice.
评估美国外科医师学会肿瘤学组（ACOSOG）Z0011试验在该研究发表后（2010年）以及2020年再次发表后对巴西腋窝乳腺癌手术管理的影响。
对巴西乳腺病学会成员进行一项调查。
在1627名乳腺外科医生中，799名（49.1%）完成并返回了问卷。对于符合Z11纳入标准的患者，在前哨淋巴结（SLN）检测为阳性后，在该研究发表前，99.2%的受访者建议进行腋窝淋巴结清扫（AD），2010年为47.5%，2020年为18.5%（p<0.001）。在保乳手术中，如果存在微转移，2.6%的医生会进行AD，30.3%会进行腋窝放疗，67.1%不会进行额外的腋窝治疗；而如果存在宏转移，这些比例分别为21.3%、52.2%和26.5%。在乳房切除术和淋巴结包膜外扩展的病例中，分别有43.4%和36%的外科医生建议进行AD。对于临床腋窝阴性且超声检查有可疑发现的情况，69%的外科医生会采用Z11方法。大多数医生在年轻患者（83.6%）以及三阴性和/或HER2阳性肿瘤（74%）的病例中应用Z11标准。在非学术机构工作、在首都以外地区工作、未获得委员会认证以及年龄≥50岁的外科医生更有可能建议进行AD。
这项调查显示，在cN0/病理检查前哨淋巴结阳性的腋窝手术管理方面发生了重大变化，尤其是在更新后的Z11结果及其他类似研究发表之后。更好的教育环境和长期随访是与在实践中纳入Z11相关变化相关的因素。
