Abstract
BackgroundThe Z0011 trial initiated a paradigm shift in the axillary treatment of breast cancer patients with a positive sentinel lymph node biopsy (SLNB), disregarding patients with a positive ultrasound-guided lymph node biopsy (UGLNB). We examined whether relevant differences exist between these patients to determine if the conclusions of the ACOSOG Z0011 trial are applicable to UGLNB-positive patients.MethodsPatients diagnosed with invasive breast cancer in the Netherlands between January 2008 and December 2014 were selected from the Netherlands Cancer Registry.ResultsA total of 11,820 cases were included: 9149 cases in the SLNB group and 2671 in the UGLNB group. Multivariate analyses showed that UGLNB-positive patients were older (p < 0.001), more likely to have a poorly differentiated tumor (p < 0.001), had a negative hormone receptor status (p < 0.001), and more often had extensive nodal involvement (p < 0.001). However, they were less likely to undergo adjuvant radiation (p = 0.004) or systemic therapy (p < 0.001). Even after adjusting for these factors, UGLNB-positive patients had a worse overall survival (HR = 1.38; 95% CI 1.23–1.56) than SLNB-positive patients.ConclusionThis nationwide retrospective study shows that young patients found positive by UGLNB have less favorable disease characteristics and a worse prognosis compared to patients with a positive SLNB. Selection by ultrasound plays an important role when axillary treatment strategies are considered. Hence, the conclusions of the Z0011 trial cannot unconditionally be applied to patients with a positive UGLNB.
Highlights
Determining the axillary lymph node status is still an important element in the diagnostic work-up of patients with invasive breast cancer
This nationwide retrospective study shows that young patients found positive by ultrasound-guided lymph node biopsy (UGLNB) have less favorable disease characteristics and a worse prognosis compared to patients with a positive sentinel lymph node biopsy (SLNB)
In order to assess whether the conclusions of the Z0011 trial can be applied to these patients, we have previously conducted a study among 302 node-positive patients to examine whether UGLNB-positive patients were comparable to SLNB selected positive patients with respect to important clinicopathological factors and prognosis
Summary
Determining the axillary lymph node status is still an important element in the diagnostic work-up of patients with invasive breast cancer This is mostly done by ultrasound-guided lymph node biopsy (UGLNB) or sentinel lymph node biopsy (SLNB) [1]. Breast Cancer Res Treat (2017) 165:555–563 treatment has become increasingly dependent on other prognostic factors, such as age, tumor size, tumor grade, hormone and HER2 receptor status, and gene expression profiles [1, 8,9,10] These developments raised questions on the necessity of performing an ALND in patients with a positive SLNB [6, 11]. We examined whether relevant differences exist between these patients to determine if the conclusions of the ACOSOG Z0011 trial are applicable to UGLNB-positive patients
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