The clinical impact of the American College of Surgeons Oncology Group Z-0011 trial – Results from the BreastSurgANZ National Breast Cancer Audit

Ainsworth, Rachel; Kollias, James; Blanc, Abbey Le; Silva, Primali de

doi:10.1016/j.breast.2012.11.005

Cited by 18 publications

(10 citation statements)

References 11 publications

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“…Our study demonstrates that applying the Z0011 criteria to the WBCI breast cancer patients, overall, only 9.3% would avoid a cALND. This number is similar to the 6.9% figure derived from the BreastSurgANZ National Breast Cancer Audit database 2005–2010, treated with breast conserving surgery with less than three positive sentinel nodes . However, if node‐negative patients were excluded, the Z0011 study would apply to a larger proportion of patients with breast cancer; in our study, to 21.5% of H&E node‐positive patients.…”

Section: Discussionsupporting

confidence: 85%

Relevance of the American College of Surgeons Oncology Group Z0011 Trial to breast cancer in the Australian setting

et al. 2013

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Background: Conventional wisdom suggests that a patient with a positive sentinel node requires a completion axillary clearance to obtain full staging and durable regional control. However, this dictum has been challenged by the recent American College of Surgeons Oncology Group Z0011 Trial demonstrating that women with node-positive breast cancer who underwent sentinel node biopsy only, and were treated with breast conserving surgery and radiation, had equivalent locoregional recurrence and survival rates to those who had a completion axillary clearance. The aim of our study was to determine what the clinical impact of the Z0011 findings might be if patients were managed according to the Z0011 criteria in an Australian teaching hospital setting. Methods: We performed a retrospective review, using prospectively collected data, of all female patients with breast cancer assessed at the Westmead Breast Cancer Institute in 2010 and identified the subgroup who would potentially have fulfilled all Z0011 criteria. The characteristics and management of this group were compared with nodepositive and to mastectomy patient subgroups. Results: A total of 280 patients with invasive breast cancer were identified. Twentysix patients satisfied all Z0011 criteria, representing 9.3% of all patients and 21.5% of node-positive patients. Twenty-two (84.6%) patients had a subsequent axillary clearance, with six (27.3%) having additional positive nodes. Conclusions: The Z0011 study is relevant to 9.3% of all breast cancer patients and 21.5% of node-positive breast cancer patients treated in a major Australian teaching hospital.

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Section: Discussionsupporting

confidence: 85%

Relevance of the American College of Surgeons Oncology Group Z0011 Trial to breast cancer in the Australian setting

et al. 2013

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“…The introduction of an Australian nephrectomy registry will likely be followed by other urology procedures, such as RC, and these data will assist to direct any quality improvements required. Analysis of practice led by large audits has been shown in other Australian specialties . For RC, Jerlström et al.…”

Section: Discussionmentioning

confidence: 99%

“…The introduction of an Australian nephrectomy registry [31] will likely be followed by other urology procedures, such as RC, and these data will assist to direct any quality improvements required. Analysis of practice led by large audits has been shown in other Australian specialties [32,33]. For RC, Jerlstr€ om et al [34] have established a prospective RC database in Sweden with preliminary analysis identifying increased operating time and older patients as risk factors for higher complication rates.…”

Section: Discussionmentioning

confidence: 99%

Hospital volume and perioperative outcomes for radical cystectomy: a population study

et al. 2017

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Objectives To evaluate the association between hospital volume and perioperative outcomes of radical cystectomy (RC) using state population data for a contemporary Australian cohort. Patients and Methods Patients undergoing RC for urothelial malignancy in the state of Victoria, Australia between July 2003 and June 2014 were identified using the Victorian Admitted Episodes Dataset (VAED). Hospitals were divided into tertiles according to their caseload per year. Hospitals performing <4 RCs/year were defined as low‐volume hospitals (LVH), 4–10 RCs/year as medium‐volume hospitals (MVH), and >10 RCs/year as high‐volume hospitals (HVH). Perioperative outcomes derived included: in‐hospital mortality (IHM), prolonged length of stay (LOS; >14 days), prolonged intensive care unit (ICU) admission (>24 h), and requirement for blood transfusion. The relationship between hospital volume and perioperative outcomes was assessed using logistic regression. Results During the 11‐year study period, 803 patients underwent RC for bladder cancer. The overall IHM rate was 2.2% (LVH 3.7%, MVH 2.5%, HVH 0.9%). Other outcomes observed were prolonged LOS (45%), prolonged ICU admission (31%) and requirement for blood transfusion (56%). On multivariate analysis, LVH was found to be associated with increased IHM (odds ratio [OR] 5.74, P = 0.04) and prolonged ICU admission (OR 11.58, P < 0.001) when compared to HVH. There was a lower rate of prolonged LOS for LVH (OR 0.60, P = 0.01). No significant relationship was identified for LVH and blood transfusion. Conclusion Perioperative outcomes in Victoria are comparable to international standards. Our results add further population study evidence to the volume–outcome relationship in RC. There was a significant association between LVH and both IHM and prolonged ICU admission. This subgroup of patients would appear to benefit from transfer of care to a HVH. The role of centralisation of RC in Australia should be further considered.

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“…Some studies estimate that less than 7% of T1 and T2 breast cancers meet the inclusion criteria stated in the Z11 trial [3, 6, 21]. Patients being treated with neoadjuvant chemotherapy (NCT), opting for mastectomy, patients undergoing partial breast radiation, patients with clinically involved nodes, three or more positive sentinel nodes, or nodes with extranodal extension on SNB fall outside the scope of the Z11 eligibility [20].…”

Section: Introductionmentioning

confidence: 99%

The Relevance of Ultrasound Imaging of Suspicious Axillary Lymph Nodes and Fine-needle Aspiration Biopsy in the Post-ACOSOG Z11 Era in Early Breast Cancer

Vijayaraghavan

Vedantham

Kataoka³

et al. 2017

Academic Radiology

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Rationale and Objective Evaluation of nodal involvement in early-stage breast cancers (T1 or T2) changed following the Z11 trial; however, not all patients meet the Z11 inclusion criteria. Hence, the relevance of ultrasound imaging of the axilla and fine-needle aspiration biopsy (FNA) in early-stage breast cancers was investigated. Materials and Methods In this single-center, retrospective study, 758 subjects had pathology-verified breast cancer diagnosis over a 3-year period, of which 128 subjects with T1/T2 breast tumors had abnormal axillary lymph nodes on ultrasound, had FNA, and proceeded to axillary surgery. Ultrasound images were reviewed and analyzed using multivariable logistic regression to identify the features predictive of positive FNA. Accuracy of FNA was quantified as the area under the receiver operating characteristic curve with axillary surgery as reference standard. Results Of 128 subjects, 61 and 65 were positive on FNA and axillary surgery, respectively. Sensitivity, specificity, positive- and negative-predictive values of FNA were 52/65 (80%), 54/63 (85.7%), 52/61(85.2%) and 54/67 (80.5%), respectively. After adjusting for neoadjuvant chemotherapy between FNA and surgery, a positive FNA was associated with higher likelihood for positive axillary surgery (odds ratio: 22.7; 95% CI: 7.2–71.3, p<0.0001), and the accuracy of FNA was 0.801 (95% CI: 0.727–0.876). Among ultrasound imaging features, cortical thickness and abnormal hilum were predictive (p<0.017) of positive FNA with accuracy of 0.817 (95% CI: 0.741–0.893). Conclusion Ultrasound imaging and FNA can play an important role in the management of early breast cancers even in the post-Z11 era. Higher weightage can be accorded to cortical thickness and hilum during ultrasound evaluation.

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The clinical impact of the American College of Surgeons Oncology Group Z-0011 trial – Results from the BreastSurgANZ National Breast Cancer Audit

Cited by 18 publications

References 11 publications

Relevance of the American College of Surgeons Oncology Group Z0011 Trial to breast cancer in the Australian setting

Relevance of the American College of Surgeons Oncology Group Z0011 Trial to breast cancer in the Australian setting

Hospital volume and perioperative outcomes for radical cystectomy: a population study

The Relevance of Ultrasound Imaging of Suspicious Axillary Lymph Nodes and Fine-needle Aspiration Biopsy in the Post-ACOSOG Z11 Era in Early Breast Cancer

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