ASO Author Reflections: Intraoperative Nomograms Based on One-Step Nucleic Acid Amplification

Excerpt

The American College of Surgeons Oncology Group (ACOSOG) Z0011 trial has demonstrated that completion axillary lymph node dissection (cALND) can be avoided for one or two sentinel lymph nodes (SLN)-positive breast cancer patients receiving breast-conserving therapy.1 Avoidance of cALND is expected to result in less arm morbidity but makes unavailable the information about the total number of axillary lymph node (ALN) metastasis, which is very important for decision making for the adjuvant chemotherapeutic regimens and the indication for regional LN irradiation. Besides, the International Breast Cancer Study Group (IBCSG) 23-01 trial has demonstrated that cALND can be avoided for one or two SLN micrometastasis-positive breast cancer patients receiving breast-conserving therapy or mastectomy.2 It should be noticed that, in this trial, SLNs were examined meticulously, i.e., entire sectioning of each SLN at 50–200-μm intervals, which would be very difficult to perform intraoperatively in a routine practice. Therefore, for SLN-positive patients who received breast-conserving therapy and no cALND, the estimation of the total ALN metastasis, especially ≤ 3 or ≥ 4, seems to be important, and for those receiving mastectomy, development of a less laborious method for intraoperative determination of SLN micrometastasis seems to be important. …