Expanding Implementation of ACOSOG Z0011 in Surgeon Practice

The purpose of this study was to examine the impact of the ACOSOG Z0011 trial results 5 years after its publication. More than 300 patients treated over 1 year were examined. Only 8% of patients who were sentinel node-positive who met Z0011 criteria underwent axillary lymph node dissection, indicating incorporation of the trial into our institution's practice. Background: After publication of American College of Surgeons Oncology Group (ACOSOG) Z0011, surgeons at our institution limited axillary surgery to sentinel lymph node dissection (SLND) in 76% of patients meeting trial eligibility criteria. Our study objective was to assess incorporation of the trial data into practice 5 years later. Patients and Methods: Patients with clinical T1-2, N0 invasive breast cancer undergoing breast conserving surgery were included. Comparisons were made between patients who underwent axillary lymph node dissection (ALND) and those that had no further surgery. Results: A total of 396 patients were included. Twelve percent (48/396) had positive SLNs; ALND was performed in 8% (4/48). Patients who underwent ALND were more likely to have 2 positive SLNs (50%, 2/4 vs. 2%, 1/44; P =.02) and microscopic extranodal extension (75%, 3/4 vs. 18%, 8/44; P =.03) than those that did not undergo ALND. Patients who underwent ALND also had a higher nomogram-predicted probability of having additional positive non-SLNs (53%) than those who had SLND alone (22%) (P =.0002). No patients had intraoperative assessment of SLNs performed. Conclusions: The practice of omitting ALND in ACOSOG Z0011-eligible patients has expanded over 5 years. Clinicopathologic features continue to impact this decision. Intraoperative SLN assessment is no longer performed.