Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 10/2016

01-10-2016 | Breast Oncology

A Population-Based Study of the Effects of a Regional Guideline for Completion Axillary Lymph Node Dissection on Axillary Surgery in Patients with Breast Cancer

Authors: Miriam W. Tsao, MD, Sylvie D. Cornacchi, MSc, Nicole Hodgson, MD, MSc, Marko Simunovic, MD, MPH, Lehana Thabane, PhD, Ji Cheng, MSc, Mary Ann O’Brien, PhD, Barbara Strang, MD, MSc, Som D. Mukherjee, MD, MSc, Peter J. Lovrics, MD

Published in: Annals of Surgical Oncology | Issue 10/2016

Login to get access

Abstract

Introduction

Evidence from the American College of Surgeons Oncology Group (ACOSOG) Z0011 trial suggests completion axillary lymph node dissection (cALND) after positive sentinel lymph node biopsy (+SLNB) does not improve outcomes in select patients, leading to practice variation. A multidisciplinary group of surgeons, oncologists, and pathologists developed a regional guideline for cALND which was disseminated in August 2012. We assessed the impact of Z0011 and the regional guideline on cALND rates.

Methods

Consecutive invasive breast cancer cases undergoing SLNB were reviewed at 12 hospitals. Patient, tumor, and process measures were collected for three time periods: TP1, before publication of Z0011 (May 2009–August 2010); TP2, after publication of Z0011 (March 2011–June 2012); and TP3, after guideline dissemination (January 2013–April 2014). Cases were categorized by whether they met the guideline criteria for cALND (i.e. ≤50 years, mastectomy, T3 tumor, three or more positive sentinel lymph nodes [SLNs]) or not (e.g. age > 50 years, breast-conserving surgery, T1/T2 tumor, and one to two positive SLNs).

Results

The SLNB rate increased from 56 % (n = 620), to 70 % (n = 774), to 78 % (n = 844) in TP1, TP2, and TP3, respectively. Among cases not recommended for cALND using the guideline criteria, cALND rates decreased significantly over time (TP1, 71 %; TP2, 43 %; TP3, 17 %) [p < 0.001]. The cALND rate also decreased over time among cases recommended to have cALND using the guideline criteria (TP1, 92 %; TP2, 69 %; TP3, 58 %) [p < 0.001]. Based on multivariable analysis, age and nodal factors appeared to be significant factors for cALND decision making.

Conclusion

Publication of ACOSOG Z0011 and regional guideline dissemination were associated with a marked decrease in cALND after +SLNB, even among several cases in which the guideline recommended cALND.
Literature
1.
Krag DN, Anderson SJ, Julian TB, et al. Sentinel-lymph-node resection compared with conventional axillary lymph node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomized phase 3 trial. Lancet Oncol. 2010;11:927–33.CrossRefPubMedPubMedCentral
2.
Purushotham AD, Upponi S, Klevesath MB, et al. Morbidity after sentinel lymph node biopsy in primary breast cancer: results from a randomized controlled trial. J Clin Oncol. 2005;23(19):4312–21.CrossRefPubMed
3.
4.
Lyman GH, Giuliano AE, Omerfield MR, et al. American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol. 2005;23:7703–20.CrossRefPubMed
5.
6.
7.
Giuliano AE, Hunt KK, Ballman KV, et al. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA. 2011;305:569–75.CrossRefPubMed
8.
Caudle AS, Hunt KK, Kuerer HM, et al. Multidisciplinary considerations in the implementation of the findings from the American College of Surgeons Oncology Group (ACOSOG) Z0011 study: a practice-changing trial. Ann Surg Oncol. 2011;18(9):2407–12.CrossRefPubMedPubMedCentral
9.
Barry JM, Weber WP, Sacchini V. The evolving role of axillary lymph node dissection in the modern era of breast cancer management. Surg Oncol. 2012;21:143–5.CrossRefPubMed
10.
11.
Latosinsky S, Berrand TS, Cutter CS, et al. Axillary dissection versus no axillary dissection in women with invasive breast cancer and sentinel node metastasis. Can J Surg. 2012;55:66–69.CrossRefPubMedPubMedCentral
12.
Giuliano AE, Morrow M, Duggal S, et al. Should ACOSOG Z0011 change practice with respect to axillary lymph node dissection for a positive sentinel lymph node biopsy in breast cancer? Clin Exp Metastasis. 2012;29:687–92.CrossRefPubMed
13.
Voutsadakis IA, Spadafora S. Axillary lymph node management in breast cancer with positive sentinel lymph node biopsy. World J Clin Oncol. 2015;6(1):1–6.CrossRefPubMedPubMedCentral
14.
Galimberti V, Chifu C, Perez SR, et al. Positive axillary sentinel lymph node: is axillary dissection always necessary? Breast. 2011;20(Suppl 3):S96–8.CrossRefPubMed
15.
Morrow M, Giuliano AE. To cut is to cure: can we really apply Z11 in practice? Ann Surg Oncol. 2011;18:2413–5.CrossRefPubMed
16.
Cody HS III, Houssami N. Axillary management in breast cancer: what’s new for 2012? Breast. 2012;21(3):411–5.CrossRefPubMed
17.
Caudle AS, Hunt KK, Tucker SL, et al. American College of Surgeons Oncology Group (ACOSOG) Z0011: impact on surgeon practice patterns. Ann Surg Oncol. 2012;19(10):3144–51.CrossRefPubMedPubMedCentral
18.
Joyce DP, Lowery AJ, McGrath-Soo LB, et al. Management of the axilla: has Z0011 had an impact? Ir J Med Sci. 2016;185(1):145–9.CrossRefPubMed
19.
Wright GP, Mater ME, Sobel HL, et al. Measuring the impact of the American College of Surgeons Oncology Group Z0011 trial on breast cancer surgery in a community healthy system. Am J Surg. 2015;209:240–5.CrossRefPubMed
20.
Jamtvedt G, Young JM, Kristoffersen DT, et al. Does telling people what they have been doing change what they do? A systematic review of the effects of audit and feedback. Qual Saf Health Care. 2006;15:433–6.CrossRefPubMedPubMedCentral
21.
Grimshaw J, Eccles M, Walter A, et al. Changing physician’s behaviour; what works and thoughts on getting more things to work. J Cont Educ Health Prof. 2002;22:237–43.CrossRef
22.
23.
24.
O’Brien MA, Oxman AD, Davis DA, et al. Educational outreach visits: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2007;(2):CD000409.
25.
26.
Lyman GH, Temin S, Edge S, et al. Sentinel lymph node biopsy for patients with early-stage breast cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2014;32:1365–86.CrossRefPubMed
27.
28.
Lovrics PJ, Hodgson N, O’Brien MA, et al. Results of a surgeon-directed quality improvement project on breast cancer surgery outcomes in South-Central Ontario. Ann Surg Oncol. 2014;21:2181–7.CrossRefPubMed
29.
30.
Fisher B, Redmond C, Fisher ER, et al. Ten-year results of a randomized clinical trial comparing radical mastectomy and total mastectomy with or without radiation. N Engl J Med. 1985;312(11):674–81.CrossRefPubMed
31.
Gatzemeier W, Mann GB. Which sentinel lymph-node (SLN) positive breast cancer patient needs an axillary lymph-node dissection (ALND)—ACOSOG Z0011 results and beyond. Breast J. 2013;22(3):211–6.CrossRef
32.
Goyal A, Dodwell D, Reed MW, et al. Axillary treatment in women with one or two sentinel nodes with macrometastases: more evidence is needed to inform practice. J Clin Oncol. 2014;32:3902.CrossRefPubMed
33.
Doherty S. History of evidence-based medicine. Oranges, chloride of lime and leeches: barriers to teaching old dogs new tricks. Emerg Med Australas. 2005;17:314–21.
34.
Langer I, Guller U, Berclaz G, et al. Morbidity of sentinel lymph node biopsy (SLN) alone versus SLN and completion axillary lymph node dissection after breast cancer surgery: a prospective Swiss multicenter study on 659 patients. Ann Surg. 2007;245(3):452–61.CrossRefPubMedPubMedCentral
35.
Yi M, Giordano SH, Meric-Bernstam F, et al. Trends in and outcomes from sentinel lymph node biopsy (SLNB) alone vs. SLNB with axillary lymph node dissection for node-positive breast cancer patients: experience from the SEER database. Ann Surg Oncol. 2010;17:343–51.CrossRefPubMedPubMedCentral
36.
Bilimoria KY, Bentrem DJ, Hansen NM, et al. Comparison of sentinel lymph node biopsy alone and completion axillary lymph node dissection for node-positive breast cancer. J Clin Oncol. 2009;27(18):2946–53.CrossRefPubMed
37.
Van Der Hage JA, Van de Velde JP, Tubiana-Hulin M, et al. Preoperative chemotherapy in primary operable breast cancer: results from the European Organization for Research and Treatment of Cancer trial 10902. J Clin Oncol. 2001;19:4224–37.PubMed
38.
Donker M, Van Tienhoven G, Straver ME, et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): a randomized, multicenter, open-label, phase 3 non-inferiority trial. Lancet Oncol. 2014;15(12):1303–10.CrossRefPubMedPubMedCentral
39.
Li CZ, Zhang P, Li RW, et al. Axillary lymph node dissection versus sentinel lymph node biopsy alone for early breast cancer with sentinel node metastasis: a meta-analysis. Eur J Surg Oncol. 2015;41:958–66.CrossRefPubMed
40.
Wang J, Mittendorf EA, Sahin AA, et al. Outcomes of sentinel lymph node dissection alone vs. axillary lymph node dissection in early stage invasive lobular carcinoma: a retrospective study of the surveillance, epidemiology and end results (SEER) database. PLoS One. 2014;9:e89778.CrossRefPubMedPubMedCentral
41.
Zakaria S, Degnim AC, Kleer CG, et al. Sentinel lymph node biopsy for breast cancer: how many nodes are enough? J Surg Oncol. 2007;96:554–9.CrossRefPubMed
42.
Lee MK, Varzi LA, Chung DU, et al. The effect of young age in hormone receptor positive breast cancer. Biomed Res Int. 2015;2015:325715.PubMedPubMedCentral
43.
44.
Natsch S, van der Meer JWM. The role of clinical guidelines, policies and stewardship. J Hosp Infect. 2003;53(3):172–6.CrossRefPubMed
Metadata
Title
A Population-Based Study of the Effects of a Regional Guideline for Completion Axillary Lymph Node Dissection on Axillary Surgery in Patients with Breast Cancer
Authors
Miriam W. Tsao, MD
Sylvie D. Cornacchi, MSc
Nicole Hodgson, MD, MSc
Marko Simunovic, MD, MPH
Lehana Thabane, PhD
Ji Cheng, MSc
Mary Ann O’Brien, PhD
Barbara Strang, MD, MSc
Som D. Mukherjee, MD, MSc
Peter J. Lovrics, MD
Publication date
01-10-2016
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 10/2016
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-016-5310-4

Other articles of this Issue 10/2016

Annals of Surgical Oncology 10/2016 Go to the issue

Breast Oncology

Operative and Oncologic Outcomes in 9861 Patients with Operable Breast Cancer: Single-Institution Analysis of Breast Conservation with Oncoplastic Reconstruction

Breast Oncology

A Prospective, Single Arm, Multi-site, Clinical Evaluation of a Nonradioactive Surgical Guidance Technology for the Location of Nonpalpable Breast Lesions during Excision

Breast Oncology

Genomic Impact of Neoadjuvant Therapy on Breast Cancer: Incomplete Response is Associated with Altered Diagnostic Gene Signatures

Breast Oncology

Current Practices and Barriers to the Integration of Oncoplastic Breast Surgery: A Canadian Perspective

Breast Oncology

Racial Differences in Utilization of Breast Conservation Surgery: Results from the National Cancer Data Base (NCDB)

Breast Oncology

Contralateral Prophylactic Mastectomy for Women with T4 Locally Advanced Breast Cancer