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The Importance of Applying ACOSOG Z0011 Criteria in the Axillary Management of Invasive Lobular Carcinoma: A Multi-institutional Cohort Study

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The American College of Surgeons Oncology Group (ACOSOG) Z0011 trial led to a significant change in the management of patients with early stage breast cancer and limited sentinel lymph node (SLN) metastases. However, only 27 patients with invasive lobular carcinoma (ILC) were randomized to the completion axillary lymph node dissection (ALND) arm. To assess the generalizability of the Z0011 trial, the primary aim of this study was to determine the risk of residual nodal burden (RNB) for ILC.

Methods

A multi-institutional cohort study was completed. RNB was determined for women of any age with an ILC and at least one positive SLN who underwent a primary breast procedure (lumpectomy or mastectomy) and both a SLN biopsy followed by a completion ALND between July 1, 1999, and June 30, 2009, at two large academic centers.

Results

A total of 59 patients (60 ILCs) met the inclusion criteria. Although the overall RNB was 40 %, it was significantly greater in the T3+ group compared to T1/T2 (87 vs. 24 %, respectively, p < 0.0001). When comparing only ILCs that met all of the inclusion criteria for ACOSOG Z0011 (T1 or T2, 1 or 2 SLNs positive, no SLN extranodal extension, and breast conservation) to those ILCs that did not, the RNB was significantly greater in the latter (56 vs. 17 %; p < 0.003).

Conclusions

Overall, the clinical practice changes that have occurred after publication of the ACOSOG Z0011 trial appear to be generalizable to ILCs within the inclusion criteria of the study.

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Acknowledgment

Research fellowship salary support was provided by the Canadian Breast Cancer Foundation to A. Roberts.

Disclosure

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Surgery, University Health Network, Toronto, ON, Canada

    Amanda Roberts MD, MPH

  2. Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Sharon Nofech-Mozes MD & Manar Al-Assi BSc

  3. Department of Pathology, Laboratory Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada

    Bruce Youngson MSc, MD

  4. Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada

    Sharon Nofech-Mozes MD & Bruce Youngson MSc, MD

  5. Division of General Surgery, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada

    David R. McCready MSc, MD

  6. Department of Surgery, University of Toronto, Toronto, ON, Canada

    Stephanie Ramkumar MD, MSc

  7. Division of General Surgery, University Health Network and Women’s College Hospital, Toronto, ON, Canada

    Tulin Cil MD, MEd

Authors
  1. Amanda Roberts MD, MPH
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  2. Sharon Nofech-Mozes MD
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  3. Bruce Youngson MSc, MD
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  4. David R. McCready MSc, MD
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  5. Manar Al-Assi BSc
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  6. Stephanie Ramkumar MD, MSc
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  7. Tulin Cil MD, MEd
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Corresponding author

Correspondence to Amanda Roberts MD, MPH.

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Roberts, A., Nofech-Mozes, S., Youngson, B. et al. The Importance of Applying ACOSOG Z0011 Criteria in the Axillary Management of Invasive Lobular Carcinoma: A Multi-institutional Cohort Study. Ann Surg Oncol 22, 3397–3401 (2015). https://doi.org/10.1245/s10434-015-4756-0

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  • DOI: https://doi.org/10.1245/s10434-015-4756-0

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