scholarly journals Validating the ACOSOG Z0011 Trial Result: A Population-Based Study Using the SEER Database

Cancers ◽  
2020 ◽  
Vol 12 (4) ◽  
pp. 950 ◽  
Author(s):  
Jiwoong Jung ◽  
Byoung Hyuck Kim ◽  
Jongjin Kim ◽  
Sohee Oh ◽  
Su-jin Kim ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Lymph Node Dissection ◽  
Population Based ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Seer Database ◽  
Node Dissection ◽  
Cancer Specific Mortality ◽  
Z0011 Trial

The Z0011 trial demonstrated that axillary lymph node dissection (ALND) could be omitted in spite of 1–2 metastatic sentinel lymph nodes. This study aimed to validate the results on a population-based database. The Surveillance, Epidemiology, and End Results (SEER) database was searched for patients comparable to the Z0011 participants. The type of axillary surgery was estimated using the total number of examined axillary lymph nodes (ALNs). Breast cancer-specific mortality (BCSM) was compared between patients with ≥10 ALNs (the sentinel lymph node dissection (SLND) and ALND group, or “SLND + ALND group”) and patients with one or two ALNs (the “SLND group”). During 2010–2015, the SEER database included 7077 and 6620 patients categorized in the SLND group and the SLND + ALND group, respectively. Death was observed for 515 patients (7.3%) in the SLND group and 589 patients (8.9%) in the SLND + ALND group based on a median follow-up of 41 months. After propensity-score matching, the adjusted hazard ratio for BCSM in the SLND group (vs. the SLND + ALND group) was 1.038 (95% confidence interval: 0.798–1.350). Regardless of the SLND criteria, the outcomes were not significantly different between the two groups. This retrospective cohort study of Z0011-comparable patients revealed that ALND could be omitted based on the Z0011 strategy, even among patients with ≤2 dissected ALNs.

scholarly journals Potential impact of application to the Z0011 trial on the omission of axillary lymph node dissection in women undergoing sentinel node biopsy: a retrospective cohort study

2020 ◽  
Author(s):  
Julia Yoriko Shinzato ◽  
Katia Piton Serra ◽  
Caroline Eugeni ◽  
Cesar Cabello ◽  
Cassio Cardoso Filho ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Axillary Lymph Node Dissection ◽  
Lymph Node Dissection ◽  
Axillary Lymph Node ◽  
Sentinel Lymph Nodes ◽  
Axillary Lymph ◽  
Node Dissection ◽  
Acosog Z0011 ◽  
Z0011 Trial

Abstract Background To evaluate the number of patients with early-stage breast cancer, undergoing axillary lymph node dissection for metastatic sentinel lymph nodes, who could benefit from the omission of axillary surgery following the application of ACOSOG Z0011 trial criteria. Methods A retrospective cohort study conducted in the Women’s Hospital of the State University of Campinas. The study population included 384 women diagnosed with early-stage invasive breast cancer, clinically negative axilla, treated with breast-conserving surgery and sentinel lymph node biopsy, radiation therapy, chemotherapy and/or endocrine therapy, from January 2005 to December 2010. ACOSOG Z0011 trial criteria were applied to this population and statistical analysis was carried out to make a comparison between populations. Results A total of 384 patients underwent breast-conserving surgery and sentinel lymph node biopsy. Of the total number of patients, 86 women underwent axillary lymph node dissection for metastatic sentinel lymph nodes. One patient underwent axillary node dissection due to a suspicious SLN intra-operatively. Among these patients, 82/87 (94.3%) had one to two involved sentinel lymph nodes and met criteria for the ACOSOG Z0011 trial with the omission of axillary lymph node dissection. Among the 82 eligible women, there were only 13 cases (15.9%) of lymphovascular invasion and 62 cases (75.6%) of tumors measuring up to 2cm in diameter (T1). Conclusions When eligibility for ACOSOG Z0011 trial criteria was retrospectively exported to our study population, 94.3% of the patients with one to two positive sentinel lymph nodes would benefit from the omission of axillary lymph node dissection. The high rate in our study may be explained by the large number of patients with tumors up to 2.0 cm in size and the small rate of lymphovascular invasion, which are indicative of a favorable prognosis.

scholarly journals Potential impact of application to the Z0011 trial on the omission of axillary lymph node dissection in women undergoing sentinel node biopsy: a retrospective cohort study

2019 ◽  
Author(s):  
Julia Yoriko Shinzato ◽  
Katia Piton Serra ◽  
Caroline Eugeni ◽  
Cesar Cabello ◽  
Cassio Cardoso Filho ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Axillary Lymph Node Dissection ◽  
Lymph Node Dissection ◽  
Axillary Lymph Node ◽  
Sentinel Lymph Nodes ◽  
Axillary Lymph ◽  
Node Dissection ◽  
Acosog Z0011 ◽  
Z0011 Trial

Abstract Background To evaluate the number of patients with early-stage breast cancer, undergoing axillary lymph node dissection for metastatic sentinel lymph nodes, who could benefit from the omission of axillary surgery following the application of ACOSOG Z0011 trial criteria.Methods A retrospective cohort study conducted in the Women’s Hospital of the State University of Campinas. The study population included 384 women diagnosed with early-stage invasive breast cancer, clinically negative axilla, treated with breast-conserving surgery and sentinel lymph node biopsy, radiation therapy, chemotherapy and/or endocrine therapy, from January 2005 to December 2010. ACOSOG Z0011 trial criteria were applied to this population and statistical analysis was carried out to make a comparison between populations.Results A total of 384 patients underwent breast-conserving surgery and sentinel lymph node biopsy. Of the total number of patients, 86 women underwent axillary lymph node dissection for metastatic sentinel lymph nodes. One patient underwent axillary node dissection due to a suspicious SLN intra-operatively. Among these patients, 82/87 (94.3%) had one to two involved sentinel lymph nodes and met criteria for the ACOSOG Z0011 trial with the omission of axillary lymph node dissection. Among the 82 eligible women, there were only 13 cases (15.9%) of lymphovascular invasion and 62 cases (75.6%) of tumors measuring up to 2cm in diameter (T1).Conclusions When eligibility for ACOSOG Z0011 trial criteria was retrospectively exported to our study population, 94.3% of the patients with one to two positive sentinel lymph nodes would benefit from the omission of axillary lymph node dissection. The high rate in our study may be explained by the large number of patients with tumors up to 2.0 cm in size and the small rate of lymphovascular invasion, which are indicative of a favorable prognosis.

scholarly journals The Findings of SPECT/CT Concerning Bypass Lymph Circulation in Lymphedema Following Breast Cancer Surgery

Healthcare ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. 471
Author(s):  
Min Young Lee ◽  
Eunjung Kong ◽  
Dong Gyu Lee
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Lymphatic Drainage ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Node Dissection ◽  
Positive Group

This study aimed to determine whether bypass circulation was present in lymphedema and its effect. This was a retrospective, cross-sectional study. Patients who underwent unilateral breast cancer surgery with axillary lymph node dissection were recruited and underwent single-photon emission tomography/computed tomography (SPECT/CT). SPECT/CT was performed to detect the three-dimensional locations of radio-activated lymph nodes. Patients with radioactivity in anatomical locations other than axillary lymph nodes were classified into a positive group. All patients received complete decongestive therapy (CDT). Exclusion criteria were as follows: History of bilateral breast cancer surgery, cervical lymph node dissection history, and upper extremity amputation. The difference in the upper extremity circumference (cm) was measured at four points: Mid-point of the upper arm, elbow, and 10 and 15 cm below the elbow. Twenty-nine patients were included in this study. Fifteen patients (51.7%) had bypass lymphatic systems on the affected side, six (20.7%) had a bypass lymphatic system with axillary lymph nodes on the unaffected side, and 11 (37.9%) showed new lymphatic drainage. The positive group showed significantly less swelling than the negative group at the mid-arm, elbow, and 15 cm below the elbow. Bypass lymphatic circulation had two patterns: Infraclavicular lymph nodes and supraclavicular and/or cervical lymph nodes. Changes in lymph drainage caused by surgery triggered the activation of the superficial lymphatic drainage system to relieve lymphedema. Superficial lymphatic drainage has a connection through the deltopectoral groove.

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