Evaluation of Non-Sentinel Lymph Node Disease in Patients Meeting the ACOSOG Z0011 Criteria with High Risk Features: Is It Safe to Omit Lymph Node Dissection?

Abstract

Background: The management of positive sentinel lymph node (SLN) in breast cancer remains a matter of debate, with growing interest in identifying patients in which axillary lymph node dissection (ALND) can be omitted. The ACOSOG Z0011 trial changed clinical practice by demonstrating no differences in locorregional recurrence and survival in pT1-T2cN0 tumors, with <3 positive SLN, treated with breast conserving surgery and adjuvant radiotherapy. However, there is still significant controversy around this trial regarding patient selection, namely under-representation of patients with tumors with high risk features. Our aim was to identify the incidence of non-sentinel lymph node metastases in a cohort of patients meeting the inclusion criteria for ACOSO Z0011, with a high incidence of high risk features.