Changes in utilization of axillary dissection in women with invasive breast cancer and sentinel node metastasis after the ACOSOG Z0011 trial

Tseng, Joshua; Alban, Rodrigo F.; Siegel, Emily; Chung, Alice; Giuliano, Armando E.; Amersi, Farin

doi:10.1111/tbj.14191

Cited by 15 publications

(12 citation statements)

References 20 publications

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“…Since the release of ACOSOG Z0011 and the Choosing Wisely Guidelines, rates of ALND have decreased from 100% to 17% leading to a 20% reduction in mean overall cost per patient 25–27 . However, the implementation and implications of this uptake on populations that have historically faced barriers in accessing high quality and high value oncologic care, such as marginalized and minoritized individuals, low individual and/or neighborhood SES, is unclear.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, there was a trend of increasing SES and higher utilization of two low value Since the release of ACOSOG Z0011 and the Choosing Wisely Guidelines, rates of ALND have decreased from 100% to 17% leading to a 20% reduction in mean overall cost per patient. [25][26][27] However, the implementation and implications of this uptake on populations that have historically faced barriers in accessing high quality and high value oncologic care, such as marginalized and minoritized individuals, low individual and/or neighborhood SES, is unclear. Emerging studies suggest minority-serving cancer centers with high-volume breast cancer cases tend to have similar uptake of clinical trial guidelines compared to academic facilities.…”

Section: Low Value Surgical Carementioning

confidence: 99%

“…Emerging studies suggest minority-serving cancer centers with high-volume breast cancer cases tend to have similar uptake of clinical trial guidelines compared to academic facilities. 26,28,29 For instance, Jackson et al showed no racial differences in receipt of ALND among women meeting ACOSOG Z0011 criteria receiving treatment in high volume centers in the National Cancer Database. 30 On the other hand, other studies have shown people who face difficulties in accessing oncologic care such as people of color, uninsured patients, individuals with lower levels of education or income are more likely to have ALND over SLNB despite current guidelines.…”

Section: Low Value Surgical Carementioning

confidence: 99%

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Neighborhood socioeconomic status and low‐value breast cancer care

Chen

Bhattacharyya

et al. 2022

Journal of Surgical Oncology

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Background The objective of this study is to examine the association between neighborhood socioeconomic status (nSES) and receipt of low‐value breast cancer procedures. Methods Patients with breast cancer diagnosed between 2010 and 2016 were identified in the Surveillance, Epidemiology, and End Results (SEER) Program. Low value procedures included: (1) axillary lymph node dissection (ALND) for patients with limited nodal disease receiving breast conservation therapy (BCT); (2) contralateral prophylactic mastectomies (CPM); and (3) sentinel lymph node biopsies (SLNB) in patients ≥70 years old with clinically node negative early‐stage hormone‐positive breast cancer. The cohort was divided by nSES. Univariable and multivariable logistic regression analysis compared the groups. Results The study included 412 959 patients. Compared to patients in high nSES areas, residing in neighborhoods with low nSES (odd ratio [OR] 2.20, 95% confidence interval [CI] 2.0−2.42) and middle nSES (OR 1.42, 95% CI 1.20−1.56) was associated with a higher probability of undergoing low value ALND. Conversely, patients in low SES neighborhoods were less likely to receive low value SLNB (OR 0.89, 95% CI 0.85−0.94) or CPM than (low nSES OR 0.75, 95% CI 0.73−0.77); middle nSES OR 0.91 (0.89−0.92) those in high SES neighborhoods. Conclusion In the SEER Program, low nSES was associated with a lower probability of low value procedures except for ALND utilization.

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Section: Discussionmentioning

confidence: 99%

Section: Low Value Surgical Carementioning

confidence: 99%

Section: Low Value Surgical Carementioning

confidence: 99%

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Neighborhood socioeconomic status and low‐value breast cancer care

Chen

Bhattacharyya

et al. 2022

Journal of Surgical Oncology

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“…Several studies around the world have identified increasing acceptance of the Z0011 results and a change in clinical practice in relation to the standard treatment of axillary lymph nodes in patients with breast cancer [35][36][37][38] .…”

Section: Discussionmentioning

confidence: 99%

Survival and recurrence with or without axillary dissection in patients with invasive breast cancer and sentinel node metastasis

Sanvido

Elias

Facina

et al. 2021

Sci Rep

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To evaluate overall survival and locoregional recurrence between patients with invasive breast tumours and sentinel node metastasis undergoing sentinel lymph node dissection (SLND) alone and those undergoing complete axillary lymph node dissection (ALND). In this retrospective cohort study, we reviewed the medical records of patients with invasive breast carcinoma who underwent lumpectomy at a public university hospital in Brazil between 2008 and 2018. We evaluated the overall survival and the locoregional recurrence using Kaplan–Meier and Cox regression analyses, respectively. Overall, 97 participants who underwent lumpectomy were enroled; 41 in the ALND group, and 56 in the SLND group, according to Z0011 criteria. Only 17% of the patients in the ALND group had an additional biopsy-proven axillary disease, and 83% were treated with complete dissection unnecessarily. The 5-year survival rates were 80.1% and 87.5% for SLND and ALND, respectively (p = 0.376). Locoregional recurrence was rare (1.7% and 7.3% in the SLND and ALND, respectively; p = 0.3075). Overall survival and locoregional recurrence were similar between the two groups. The de-escalation of ALND to SLND in women with metastasis in the sentinel lymph node treated with conservative surgery and radiotherapy that meet the Z0011 criteria is feasible even in developing countries.

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“…If patients’ evidence micro-metastases or only 1 or 2 metastatic SLNs, ALND can be omitted without compromising the oncological outcomes. Since the publication of these studies, the ALND rate has markedly decreased worldwide [ 4 5 ]. This raises the question of whether intraoperative SLN frozen section biopsy is required.…”

Section: Introductionmentioning

confidence: 99%

Avoiding unnecessary intraoperative sentinel lymph node frozen section biopsy of patients with early breast cancer

et al. 2022

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Purpose After the publication of the ACOSOG (American College of Surgeons Oncology Group) Z0011 trial, the rate of axillary lymph node dissection has reduced. Thus, the need for intraoperative frozen section biopsy of sentinel lymph nodes (SLNs) has become controversial. We identified patients for whom intraoperative SLN frozen section biopsy could be omitted and found that frozen section biopsy rate can be reduced. Methods We reviewed the records of patients with tumors ≤5 cm in diameter who underwent breast-conserving surgery between January 2013 and December 2019 at Seoul St. Mary’s Hospital. Clinicopathological and imaging characteristics were compared according to number of positive SLNs (0–2 SLNs positive vs. ≥3 SLNs positive). Results A total of 1,983 patients were included in this study. Thirty-two patients (1.6%) had at least 3 positive SLNs. Patients with ≥3 positive SLNs had significantly larger tumors and were more frequently high-grade tumors (P < 0.001 and P = 0.002, respectively). Identification of suspicious lymph nodes on imaging studies was also associated with the presence of ≥3 positive SLNs (hazard ratio, 11.54; 95% confidence interval, 4.42–30.10). All patients with none or only 1 suspicious lymph node on any imaging modality (n = 647, 32.6%) had 0–2 positive SLNs. Also, among patients with clinical T1-stage tumors and at least 2 suspicious lymph nodes on only 1 imaging modality (n = 514, 25.9%), only 2 cases had ≥3 positive SLNs. Conclusion We found that intraoperative SLN frozen biopsy could be omitted in patients using tumor size and axillary lymph node status on imaging modality.

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Changes in utilization of axillary dissection in women with invasive breast cancer and sentinel node metastasis after the ACOSOG Z0011 trial

Cited by 15 publications

References 20 publications

Neighborhood socioeconomic status and low‐value breast cancer care

Neighborhood socioeconomic status and low‐value breast cancer care

Survival and recurrence with or without axillary dissection in patients with invasive breast cancer and sentinel node metastasis

Avoiding unnecessary intraoperative sentinel lymph node frozen section biopsy of patients with early breast cancer

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