ASO Author Reflections: Refining Risk Assessment in Node-Positive Breast Cancer Patients Eligible for Sentinel Lymph Node Biopsy Alone

Excerpt

The American College of Surgeons Oncology Group (ACOSOG) Z0011 trial transformed the treatment of early-stage breast cancers by demonstrating the safety of omitting axillary dissection (ALND) for T1-T2, clinically node-negative (T1-T2cN0) patients with one or two positive sentinel nodes (SLNs) undergoing breast-conservation therapy.1 Adoption of this approach has maintained excellent oncologic outcomes while avoiding overtreatment in the axilla by using a multidisciplinary approach to achieve locoregional control for patients with limited nodal disease. However, in the modern era of surgical de-escalation, it remains crucial to accurately identify patients at highest risk of a significant residual nodal disease burden and to individualize treatment when appropriate. High-risk features not examined in early trials, such as microscopic extracapsular extension (mECE), have been associated with an increased residual nodal burden for patients with limited SLN metastases.2^,3 This study sought to examine the significance of extranodal tumor deposits (ETDs) in the axillary fat of such patients, something unknown before the current study.4 …