open access

Vol 66, No 2 (2016)
Research paper (original)
Published online: 2016-06-01
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Preliminary report on the effect of implementation of conclusions from the ACOSOG Z0011 trial on the changes in the diagnostic and therapeutic management strategy in breast cancer patients subjected to sentinel node biopsy

Tomasz Nowikiewicz, Magdalena Wiśniewska, Michał Wiśniewski, Wojciech Zegarski
DOI: 10.5603/NJO.2016.0019
·
Nowotwory. Journal of Oncology 2016;66(2):103-108.

open access

Vol 66, No 2 (2016)
Original article
Published online: 2016-06-01

Abstract

Background. Publication of the results of the randomised ACOSOG Z0011 trial concerning the possibilities of conservative treatment of breast cancer patients with macrometastasis in the sentinel lymph node (SLN) increased the interest in this therapeutic option. The objective of the study was to assess the practical effects of the implementation of conclusions from the aforementioned study as well as clinical consequences of abandoning intraoperative verification of sentinel lymph nodes resected during the surgical procedure.

Material and methods. A prospective analysis was made for 567 breast cancer patients subjected to sentinel node biopsy in the period 1 January to 31 October 2014. In the case of the group undergoing breast conserving treatment (BCT), routine intraoperative assessment of SLN was abandoned. The decision regarding potential radicalisation of the surgical procedure was delayed until final histopathological results were obtained. The results were compared with data from the period preceding the implementation of changes.

Results. BCT was used in 73.4% of study subjects while breast amputation was performed in the remaining patients. Presence of metastatic lesions within the SLNs was detected in 23.5% of patients. In 31.8% of patients with SLN metastases, radicalisation of the surgery was abandoned versus 18.3% in the control group, 22.2% versus 5.1% in case of macrometastases; 28.0% versus 6.5% in patients undergoing BCT. These are significant results, p < 0.05). The percentage of patients subjected to reoperation was 6.9% versus 3.6% in the control group.

Conclusions. Postponing the decision regarding the potential radicalisation of surgical treatment until the receipt of the final result of the histopathological sentinel node assessment may facilitate the choice of further treatment. Abandonment of routine intraoperative assessment of SLN allowed for a statistically significant increase in the percentage of follow-up axillary lymph node resection being abandoned. At the same time, no significant increase in the rate of reoperations was observed.  

Abstract

Background. Publication of the results of the randomised ACOSOG Z0011 trial concerning the possibilities of conservative treatment of breast cancer patients with macrometastasis in the sentinel lymph node (SLN) increased the interest in this therapeutic option. The objective of the study was to assess the practical effects of the implementation of conclusions from the aforementioned study as well as clinical consequences of abandoning intraoperative verification of sentinel lymph nodes resected during the surgical procedure.

Material and methods. A prospective analysis was made for 567 breast cancer patients subjected to sentinel node biopsy in the period 1 January to 31 October 2014. In the case of the group undergoing breast conserving treatment (BCT), routine intraoperative assessment of SLN was abandoned. The decision regarding potential radicalisation of the surgical procedure was delayed until final histopathological results were obtained. The results were compared with data from the period preceding the implementation of changes.

Results. BCT was used in 73.4% of study subjects while breast amputation was performed in the remaining patients. Presence of metastatic lesions within the SLNs was detected in 23.5% of patients. In 31.8% of patients with SLN metastases, radicalisation of the surgery was abandoned versus 18.3% in the control group, 22.2% versus 5.1% in case of macrometastases; 28.0% versus 6.5% in patients undergoing BCT. These are significant results, p < 0.05). The percentage of patients subjected to reoperation was 6.9% versus 3.6% in the control group.

Conclusions. Postponing the decision regarding the potential radicalisation of surgical treatment until the receipt of the final result of the histopathological sentinel node assessment may facilitate the choice of further treatment. Abandonment of routine intraoperative assessment of SLN allowed for a statistically significant increase in the percentage of follow-up axillary lymph node resection being abandoned. At the same time, no significant increase in the rate of reoperations was observed.  

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About this article
Title

Preliminary report on the effect of implementation of conclusions from the ACOSOG Z0011 trial on the changes in the diagnostic and therapeutic management strategy in breast cancer patients subjected to sentinel node biopsy

Journal

Nowotwory. Journal of Oncology

Issue

Vol 66, No 2 (2016)

Article type

Research paper (original)

Pages

103-108

Published online

2016-06-01

DOI

10.5603/NJO.2016.0019

Bibliographic record

Nowotwory. Journal of Oncology 2016;66(2):103-108.

Authors

Tomasz Nowikiewicz
Magdalena Wiśniewska
Michał Wiśniewski
Wojciech Zegarski

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