Melissa Pilewskie1, Maxine Jochelson2, Jessica C Gooch1, Sujata Patil3, Michelle Stempel1, Monica Morrow4. 1. Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY. 2. Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY. 3. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY. 4. Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY. Electronic address: morrowm@mskcc.org.
Abstract
BACKGROUND: American College of Surgeons Oncology Group (ACOSOG) Z0011 results support the omission of axillary lymph node dissection (ALND) in women with less than 3 positive sentinel lymph nodes (SLNs) undergoing breast-conserving surgery (BCS) and radiation therapy. We sought to determine if abnormal axillary imaging is predictive of the need for ALND in this population. STUDY DESIGN: Patients with cT1-2N0 breast cancer by physical examination undergoing BCS were managed according to Z0011 criteria independent of axillary imaging. Patient characteristics and rates of ALND were compared among those with and without abnormal lymph nodes (LNs) detected by mammogram, ultrasound (US), or MRI. All available axillary imaging was reviewed by 1 breast radiologist. RESULTS: Between August 2010 and December 2013, 3,253 breast cancer patients were treated with BCS and SLN biopsy; 425 patients met Z0011 criteria (cT1-2N0) and had nodal metastasis on SLN biopsy. Clinicopathologic features were median patient age, 58 years; median tumor size, 1.8 cm; 85% ductal histology; and 89% estrogen receptor positive. All women had a mammogram, 242 had axillary US, 172 had MRI. Abnormal LNs were seen on 7%, 25%, and 30% of mammograms, US, and MRIs, respectively. Although abnormal LNs on mammogram or US were associated with a significant increase in ALND and a non-significant trend was seen with MRI, 68% to 73% of women with abnormal axillary imaging did not require ALND. CONCLUSIONS: Among clinically node-negative patients with abnormal axillary imaging, 71% did not meet criteria for ALND and were spared further surgical morbidity. Abnormal nodes on US, MRI, or mammogram in clinically node-negative patients are not reliable indicators of the need for ALND.
BACKGROUND: American College of Surgeons Oncology Group (ACOSOG) Z0011 results support the omission of axillary lymph node dissection (ALND) in women with less than 3 positive sentinel lymph nodes (SLNs) undergoing breast-conserving surgery (BCS) and radiation therapy. We sought to determine if abnormal axillary imaging is predictive of the need for ALND in this population. STUDY DESIGN:Patients with cT1-2N0 breast cancer by physical examination undergoing BCS were managed according to Z0011 criteria independent of axillary imaging. Patient characteristics and rates of ALND were compared among those with and without abnormal lymph nodes (LNs) detected by mammogram, ultrasound (US), or MRI. All available axillary imaging was reviewed by 1 breast radiologist. RESULTS: Between August 2010 and December 2013, 3,253 breast cancerpatients were treated with BCS and SLN biopsy; 425 patients met Z0011 criteria (cT1-2N0) and had nodal metastasis on SLN biopsy. Clinicopathologic features were median patient age, 58 years; median tumor size, 1.8 cm; 85% ductal histology; and 89% estrogen receptor positive. All women had a mammogram, 242 had axillary US, 172 had MRI. Abnormal LNs were seen on 7%, 25%, and 30% of mammograms, US, and MRIs, respectively. Although abnormal LNs on mammogram or US were associated with a significant increase in ALND and a non-significant trend was seen with MRI, 68% to 73% of women with abnormal axillary imaging did not require ALND. CONCLUSIONS: Among clinically node-negative patients with abnormal axillary imaging, 71% did not meet criteria for ALND and were spared further surgical morbidity. Abnormal nodes on US, MRI, or mammogram in clinically node-negative patients are not reliable indicators of the need for ALND.
Authors: Vincent E Mortellaro; Julia Marshall; Lauren Singer; Steven N Hochwald; Myron Chang; Edward M Copeland; Stephen R Grobmyer Journal: J Magn Reson Imaging Date: 2009-08 Impact factor: 4.813
Authors: Hiroyuki Abe; David Schacht; Charlene A Sennett; Gillian M Newstead; Robert A Schmidt Journal: AJR Am J Roentgenol Date: 2013-03 Impact factor: 3.959
Authors: Tina J Hieken; Brent C Trull; Judy C Boughey; Katie N Jones; Carol A Reynolds; Sejal S Shah; Katrina N Glazebrook Journal: Surgery Date: 2013-10 Impact factor: 3.982
Authors: E E Deurloo; P J Tanis; K G A Gilhuijs; S H Muller; R Kröger; J L Peterse; E J Th Rutgers; R Valdés Olmos; L J Schultze Kool Journal: Eur J Cancer Date: 2003-05 Impact factor: 9.162
Authors: Viviana Galimberti; Bernard F Cole; Stefano Zurrida; Giuseppe Viale; Alberto Luini; Paolo Veronesi; Paola Baratella; Camelia Chifu; Manuela Sargenti; Mattia Intra; Oreste Gentilini; Mauro G Mastropasqua; Giovanni Mazzarol; Samuele Massarut; Jean-Rémi Garbay; Janez Zgajnar; Hanne Galatius; Angelo Recalcati; David Littlejohn; Monika Bamert; Marco Colleoni; Karen N Price; Meredith M Regan; Aron Goldhirsch; Alan S Coates; Richard D Gelber; Umberto Veronesi Journal: Lancet Oncol Date: 2013-03-11 Impact factor: 41.316
Authors: Anthony Lucci; Linda Mackie McCall; Peter D Beitsch; Patrick W Whitworth; Douglas S Reintgen; Peter W Blumencranz; A Marilyn Leitch; Sukumal Saha; Kelly K Hunt; Armando E Giuliano Journal: J Clin Oncol Date: 2007-05-07 Impact factor: 44.544
Authors: Hee Yong Kwak; Byung Joo Chae; Ja Seong Bae; Eun Jin Kim; Eun Young Chang; Sang Hoon Kim; Sang Seol Jung; Byung Joo Song Journal: World J Surg Oncol Date: 2013-05-21 Impact factor: 2.754
Authors: Rachelle Crescenzi; Paula M Donahue; Vaughn G Braxton; Allison O Scott; Helen B Mahany; Sarah K Lants; Manus J Donahue Journal: NMR Biomed Date: 2018-10-12 Impact factor: 4.044
Authors: Monica Morrow; Kimberly J Van Zee; Sujata Patil; Oriana Petruolo; Anita Mamtani; Andrea V Barrio; Deborah Capko; Mahmoud El-Tamer; Mary L Gemignani; Alexandra S Heerdt; Laurie Kirstein; Melissa Pilewskie; George Plitas; Virgilio S Sacchini; Lisa M Sclafani; Alice Ho; Hiram S Cody Journal: Ann Surg Date: 2017-09 Impact factor: 12.969