Changing Behavior in Clinical Practice in Response to the ACOSOG Z0011 Trial: A Survey of the American Society of Breast Surgeons

Gainer, Sarah M.; Hunt, Kelly K.; Beitsch, Peter D.; Caudle, Abigail S.; Mittendorf, Elizabeth A.; Lucci, Anthony

doi:10.1245/s10434-012-2523-z

Cited by 83 publications

(43 citation statements)

References 27 publications

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“…3,13 These findings have dramatically changed surgical practice, with more than half of all American surgeons, who were surveyed in 2012, stating that they had omitted ALND for patients who met Z0011 criteria. 11 Such a major shift in surgical practice has likely had an impact on most pathology practices as well.…”

Section: Commentmentioning

confidence: 99%

“…9 Although the ASCO guidelines provide an online appendix addressing pathologic evaluation of SLNB and known limitations of frozen section diagnosis, the guidelines do not encourage or discourage the use of frozen section diagnosis for SLNB. 8 Although much has been published regarding changes in surgical practice since Z0011, 5,6,[10][11][12] to our knowledge this is the first study to acknowledge Z0011's effect on pathology practice. Prior to the published Z0011 trial results, the vast majority of SLNBs were sent for frozen section diagnosis at our institution.…”

mentioning

confidence: 99%

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Decline in Frozen Section Diagnosis for Axillary Sentinel Lymph Nodes as a Result of the American College of Surgeons Oncology Group Z0011 Trial

Bishop¹,

Sun²,

Ajkay³

et al. 2015

Archives of Pathology &Amp; Laboratory Medicine

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Context.-Results of the American College of SurgeonsOncology Group Z0011 trial showed that patients with early-stage breast cancer and limited sentinel node metastasis treated with breast conservation and systemic therapy did not benefit from axillary lymph node dissection. Subsequently, most pathology departments have likely seen a decrease in frozen section diagnosis of sentinel lymph nodes.Objective.-To determine the effect of the Z0011 trial on pathology practice and to examine the utility of intraoperative sentinel lymph node evaluation for this subset of patients.Design.-Pathology reports from cases of primary breast cancer that met Z0011 clinical criteria and were initially treated with lumpectomy and sentinel lymph node biopsy from 2009 to 2015 were collected. Clinicopathologic data were recorded.Results.-Sentinel lymph node biopsies sent for frozen section diagnosis occurred in 22 of 22 cases (100%) in 2009 and 15 of 22 cases (68%) in 2010 during the pre-Z0011 years, and in 3 of 151 cases (2%) collected in 2011 through 2015, considered to be post-Z0011 years. Of the 151 post-Z0011 cases, 28 (19%) had sentinel lymph nodes with metastasis, and 147 (97%) were spared axillary lymph node dissection.Conclusions.-Following Z0011, intraoperative sentinel lymph node evaluation has significantly decreased at our institution. Prior to surgery, all patients had clinically node-negative disease. After sentinel lymph node evaluation, 97% (147 of 151) of the patients were spared axillary lymph node dissection. Therefore, routine frozen section diagnosis for sentinel lymph node biopsies can be avoided in these patients.

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Section: Commentmentioning

confidence: 99%

mentioning

confidence: 99%

Decline in Frozen Section Diagnosis for Axillary Sentinel Lymph Nodes as a Result of the American College of Surgeons Oncology Group Z0011 Trial

Bishop¹,

Sun²,

Ajkay³

et al. 2015

Archives of Pathology &Amp; Laboratory Medicine

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“…10,11 Survey studies indicate a shift in thought regarding approach to the axilla following Z0011. 12,13 Other studies have examined the hypothetical impact of applying the study criteria across different populations. [14][15][16] Despite these findings, only one study from MD Anderson Cancer Center has been published to date evaluating the actual impact of this study on clinical practice.…”

mentioning

confidence: 99%

Measuring the impact of the American College of Surgeons Oncology Group Z0011 trial on breast cancer surgery in a community health system

Wright

Mater

Sobel

et al. 2015

The American Journal of Surgery

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“…Recent studies have suggested that patients with micro-metastatic SLN can avoid complete nodal dissection (5–7). By contrast, a conservative surgical approach of patients with macrometastatic SLN is highly debated and still unaddressed (8–10). Great effort is thus requested to pathologists in the evaluation and quantification of the tumor burden in SLN.…”

Section: Introductionmentioning

confidence: 99%

One-Step Nucleic Acid Amplification in Breast Cancer Sentinel Lymph Node: A Single Institutional Experience and a Short Review

et al. 2015

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Sentinel lymph node (SLN) examination is a standard in breast cancer patients, with several methods employed along its 20 years history, the last one represented by one-step nucleic acid amplification (OSNA). The latter is a intra-operative molecular assay searching for CK19 mRNA as a surrogate of metastatic cells. Our 3 years experience with OSNA (1122 patients) showed results overlapping those recorded in the same institution with a morphological evaluation (930 patients) of SLN. In detail, the data of OSNA were almost identical to those observed with standard post-operative procedure in terms of patients with positive SLN (30%) and micrometastatic/macrometastatic involvement of SLN (respectively, 38–45 and 62–55%). By contrast, when OSNA was compared to the standard intraoperatory procedure, it was superior in terms of accuracy, prompting the use of this molecular assay as a very valid, and reproducible for intra-operative evaluation of SLN. Further possibilities prompting the use of OSNA range from adhesion to quality control programs, saving of medical time, ability to predict, during surgery, additional nodal metastasis, and molecular bio-banking.

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Changing Behavior in Clinical Practice in Response to the ACOSOG Z0011 Trial: A Survey of the American Society of Breast Surgeons

Cited by 83 publications

References 27 publications

Decline in Frozen Section Diagnosis for Axillary Sentinel Lymph Nodes as a Result of the American College of Surgeons Oncology Group Z0011 Trial

Decline in Frozen Section Diagnosis for Axillary Sentinel Lymph Nodes as a Result of the American College of Surgeons Oncology Group Z0011 Trial

Measuring the impact of the American College of Surgeons Oncology Group Z0011 trial on breast cancer surgery in a community health system

One-Step Nucleic Acid Amplification in Breast Cancer Sentinel Lymph Node: A Single Institutional Experience and a Short Review

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