The post ACOSOG Z0011 era: Does our new understanding of breast cancer really change clinical practice?

Predictive Factors for Non-Sentinel Lymph Node Metastasis in Patients with ACOSOG Z0011 Criteria

“…Publications related to the changes generated by these results in countries like Spain include patients with mastectomy and SLN positivity not receiving ALND in 10.96% [15]. Adequate analyses have shown that in European centers less than 10% of patients could benefit from this practice [5,16], equating to 8.12% of the patients with SLN detection in our analysis. However, this population comprises 35% of the patients with positive SLN biopsy, making them candidates for avoiding ALND.…”

“…The ACOSOG Z0011 trial included women with T1-2 tumors treated with breast conserving surgery (BCS) and with 1 or 2 positive SLN, presuming a low-risk population. In consequence, applying these criteria to the general population of women with breast cancer must be done with caution and may need more evaluation [3,4,5]. …”

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

“…[6][7][8][9] Critics have pointed out that the study was initially closed because of slow accrual and that the follow-up period has not been sufficient to adequately address locoregional recurrence or survival. 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.…”

A Paradigm Shift in Axillary Breast Cancer Treatment; From “Treat All-Except,” Toward “Treat None-Unless”

“…23 Based on the results of this study and of several other patient series many centres had already stopped performing completion ALND in patients with micrometastatic disease in the axilla. 23,24 One of the concerns is that premature implementation of the results of the Z0011 trial can result in hazardous undertreatment in a considerable number of patients. 24 24 Recently, it has been shown that due to significant differences in patient characteristics between those selected by ultrasound guided lymph node biopsy(UGLNB) versus immediate SLNB, the ACOSOG Z0011 trial conclusions seem as yet only applicable to patients with a positive axilla found by SLNB.…”