Abstract
BackgroundThe American College of Surgeons Oncology Group (ACOSOG) Z0011 trial demonstrated no difference in local-regional recurrence (LRR), disease-specific survival (DSS) or overall survival (OS) for sentinel lymph node dissection (SLND) and completion axillary lymph node dissection (ALND) among patients undergoing breast-conserving therapy for clinical T1–T2, N0 breast cancer with 1 or 2 positive SLNs. However, Only 7% of study participants had invasive lobular carcinoma (ILC). Because ILC has a different pattern of metastases, frequently presenting as small foci requiring immunohistochemistry for detection, the applicability of ACOSOG Z0011 trial data to ILC patients is unclear.Study DesignWe identified all ILC patients in the Surveillance, Epidemiology, and End Results (SEER) database (1998–2009) who met the ACOSOG Z0011 eligibility criteria. Patients were evaluated on the basis of the extent of axillary surgery (SLND alone or ALND), and the clinical outcomes of these 2 groups were compared.Results1269 patients (393 SLND and 876 ALND) were identified from the SEER database. At a median follow-up time of 71 months, there were no differences in OS or disease-specific survival between the two groups.ConclusionSLND alone may result in outcomes comparable to those achieved with ALND for patients with early-stage ILC who meet the ACOSOG Z0011 eligibility criteria.
Highlights
Sentinel lymph node dissection (SLND) is the standard method of nodal staging in patients with clinically node-negative breast cancer
sentinel lymph node dissection (SLND) alone may result in outcomes comparable to those achieved with axillary lymph node dissection (ALND) for patients with early-stage invasive lobular carcinoma (ILC) who meet the American College of Surgeons Oncology Group (ACOSOG) Z0011 eligibility criteria
There were no local-regional recurrence (LRR) reported in the SLND group and only 3 (0.21%) ipsilateral breast tumor recurrence (IBTR) and 1 (0.07%) regional recurrence was reported in the ALND group, indicating that LRR is uncommon after breast conserving therapy (BCT) among these patients with T1–T2 ILC with 1–2 positive nodal metastases
Summary
Sentinel lymph node dissection (SLND) is the standard method of nodal staging in patients with clinically node-negative breast cancer. Until the publication of the American College of Surgeons Oncology Group (ACOSOG) Z0011 trial results, completion axillary lymph node dissection (ALND) was recommended when the sentinel lymph node (SLN) demonstrated metastatic carcinoma. The ACOSOG Z0011 randomized trial was designed to determine whether SLND alone was not inferior to completion ALND in patients with clinical T1–T2, N0 breast cancer found to have one or two positive SLNs. All patients in the Z0011 trial underwent breast conserving therapy (BCT), including lumpectomy and whole breast irradiation. The American College of Surgeons Oncology Group (ACOSOG) Z0011 trial demonstrated no difference in local-regional recurrence (LRR), disease-specific survival (DSS) or overall survival (OS) for sentinel lymph node dissection (SLND) and completion axillary lymph node dissection (ALND) among patients undergoing breast-conserving therapy for clinical T1–T2, N0 breast cancer with 1 or 2 positive SLNs. Only 7% of study participants had invasive lobular carcinoma (ILC). Because ILC has a different pattern of metastases, frequently presenting as small foci requiring immunohistochemistry for detection, the applicability of ACOSOG Z0011 trial data to ILC patients is unclear
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