Abstract
Giuliano et al 1 recently published the results of the American College of Surgical Oncology Group (ACSOG) Z0011 trial, which evaluated 891 women with clinical T1-T2 invasive breast cancer, no palpable adenopathy, and either 1 or 2 sentinel lymph nodes (SLN) that contained metastases on frozen section (hematoxylin and eosin, or touch preparation), randomized to undergo only SLN biopsy (SLNB) or SLNB with axillary lymph node dissection (ALND). Five-year overall survival (OS) was 91.8% (95% CI, 89.1%-94.5%) after ALND and 92.5% (95% CI, 90.0%-95.1%) after SLNB only. Disease-free survival (DFS) was 82.2% (ALND) and 83.9% (SLNB only). These investigators concluded that ALND did not alter survival in women with limited SLN metastatic breast cancer who underwent breast conservation and received systemic therapy. 1 ACSOG Z0011 trial represents a landmark trial in the surgical management of clinically node negative breast cancer; however, their resultsaremarkedlydifferentfromotherreportssuchastheNational Surgical Adjuvant Breast and Bowel Project (NSABP) B04 with respect to locoregional recurrence (LRR). Before these recommendations are widely adopted, several additional questions that may contribute to LRR remain, either due to 1. Tumor burden and non-SLN involvement 2. Receptor status
Published Version
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