Abstract
BACKGROUND: Findings of the American College of Surgeons Oncology Group (ACOSOG) Z11 trial have proven controversial, leaving physicians divided over which patients with positive sentinel lymph nodes (+SLNs) benefit from axillary lymph node dissection (ALND). We reviewed our experience at our institution with Z11-eligible patients who did not undergo ALND and explored factors that predicted for positive lymph nodes (+LNs) on ALND after 1 to 2 +SLNs to determine which patients benefit from adjuvant therapy. MATERIALS AND METHODS: All breast cancer pathology reports from our institution containing the word "sentinel" between July 1998 and December 2001 were reviewed. We obtained follow-up information on patients meeting Z11 eligibility criteria who did not undergo ALND. We also compared pathological characteristics between patients with 1 to 2 +SLNs and +LNs on ALND to those with no further +LNs. RESULTS: Of the 432 pathology reports reviewed, 38 were from patients meeting Z11 criteria who did not undergo ALND. At a median follow-up of 11.9 years, these patients had 5-year overall survival (OS) of 93.3% and 10-year OS of 79.3%. No patient had recurrent disease in the axilla. Of the 80 patients with 1 to 2 +SLNs who underwent ALND, tumors with +LNs on ALND were generally larger, nonductal histology, more likely to be estrogen receptor positive (ER(+)) and progesterone receptor positive (PR(+)), and less likely to be HER2(+). CONCLUSION: Our institution's 5-year OS (93.3%) for Z11-eligible patients closely resembled those from the Z11 trial (92.5%) and our 10-year data provide evidence of what to expect for Z11-enrolled patients with continued follow-up. Larger tumor, nonductal, ER(+), PR(+), and HER2- were predictive for further +LNs on ALND, which might reflect surgical bias.