Ingrid G M Poodt1, Pauline E R Spronk2,3, Guusje Vugts1, Thijs van Dalen4, M T F D Vrancken Peeters5, Marjolijn L Rots4, Anne Kuijer4, Grard A P Nieuwenhuijzen1, Robert-Jan Schipper1. 1. Department of Surgery, Catharina Hospital Eindhoven, The Netherlands. 2. Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands. 3. Department of Research, Dutch Institute for Clinical Auditing (DICA), Leiden, The Netherlands. 4. Department of Surgery, Diakonessen Hospital, Utrecht, The Netherlands. 5. Department of Surgery, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital (NKI-AVL), Amsterdam, The Netherlands.
Abstract
OBJECTIVES: To evaluate patterns of care in axillary surgery for Dutch clinical T1-4N0M0 (cT1-4N0M0) breast cancer patients and to assess the effect of the American College for Surgeons Oncology Group (ACOSOG)-Z0011 and After Mapping of the Axilla: Radiotherapy Or Surgery (AMAROS) trial on axillary surgery patterns in Dutch cT1-2N0M0 sentinel node positive breast cancer patients. BACKGROUND: Since publication of the ACOSOG-Z0011 and AMAROS trial, omitting a completion axillary lymph node dissection (cALND) in sentinel node positive breast cancer patients is proposed in selected patients. METHODS: Data were obtained from the nationwide Nationaal Borstkanker Overleg Nederland breast cancer audit. Descriptive analyses were used to demonstrate trends in axillary surgery. Multivariable logistic regression analyses were used to identify factors associated with the omission of cALND in cT1-2N0M0 sentinel node-positive breast cancer patients. RESULTS: Between 2011 and 2015 in cT1-4N0M0 breast cancer patients, the use of sentinel lymph node biopsy as definitive axillary staging increased from 72% to 93%, and (c)ALND as definitive axillary staging decreased from 24% to 6% (P < 0.001). The use of cALND decreased from 75% to 17% in cT1-2N0 sentinel node-positive patients (P < 0.001). Earlier year of diagnosis, lower age, primary mastectomy, invasive lobular subtype, increasing tumor grade, and treatment in a nonteaching hospital were associated with a lower probability of omitting cALND (P < 0.001). CONCLUSIONS: This study shows a trend towards less extensive axillary surgery in Dutch cT1-T4N0M0 breast cancer patients; illustrated by an overall increase of sentinel lymph node biopsy and decrease in cALND. Despite this trend, particularly noticed in cT1-2N0 sentinel node-positive patients after publication of the ACOSOG-Z0011 and AMAROS trial, variations in patterns of care in axillary surgery are still present.
OBJECTIVES: To evaluate patterns of care in axillary surgery for Dutch clinical T1-4N0M0 (cT1-4N0M0) breast cancerpatients and to assess the effect of the American College for Surgeons Oncology Group (ACOSOG)-Z0011 and After Mapping of the Axilla: Radiotherapy Or Surgery (AMAROS) trial on axillary surgery patterns in Dutch cT1-2N0M0 sentinel node positive breast cancerpatients. BACKGROUND: Since publication of the ACOSOG-Z0011 and AMAROS trial, omitting a completion axillary lymph node dissection (cALND) in sentinel node positive breast cancerpatients is proposed in selected patients. METHODS: Data were obtained from the nationwide Nationaal Borstkanker Overleg Nederland breast cancer audit. Descriptive analyses were used to demonstrate trends in axillary surgery. Multivariable logistic regression analyses were used to identify factors associated with the omission of cALND in cT1-2N0M0 sentinel node-positive breast cancerpatients. RESULTS: Between 2011 and 2015 in cT1-4N0M0 breast cancerpatients, the use of sentinel lymph node biopsy as definitive axillary staging increased from 72% to 93%, and (c)ALND as definitive axillary staging decreased from 24% to 6% (P < 0.001). The use of cALND decreased from 75% to 17% in cT1-2N0 sentinel node-positive patients (P < 0.001). Earlier year of diagnosis, lower age, primary mastectomy, invasive lobular subtype, increasing tumor grade, and treatment in a nonteaching hospital were associated with a lower probability of omitting cALND (P < 0.001). CONCLUSIONS: This study shows a trend towards less extensive axillary surgery in Dutch cT1-T4N0M0 breast cancerpatients; illustrated by an overall increase of sentinel lymph node biopsy and decrease in cALND. Despite this trend, particularly noticed in cT1-2N0 sentinel node-positive patients after publication of the ACOSOG-Z0011 and AMAROS trial, variations in patterns of care in axillary surgery are still present.
Authors: Fabian Riedel; Jörg Heil; Manuel Feißt; Mahdi Rezai; Mareike Moderow; Christof Sohn; Florian Schütz; Michael Golatta; André Hennigs Journal: Breast Cancer Res Treat Date: 2019-06-24 Impact factor: 4.872
Authors: Nina Tamirisa; Hannah V Williamson; Samantha M Thomas; Kelly E Westbrook; Rachel A Greenup; Jennifer K Plichta; Laura H Rosenberger; Terry Hyslop; Eun-Sil Shelley Hwang; Oluwadamilola M Fayanju Journal: J Surg Oncol Date: 2019-05-06 Impact factor: 3.454