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Microscopic Extracapsular Extension in Sentinel Lymph Nodes Does Not Mandate Axillary Dissection in Z0011-Eligible Patients

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

Abstract

Background

In the ACOSOG (American College of Surgeons Oncology Group) Z0011 trial and the AMAROS (After Mapping of the Axilla: Radiotherapy or Surgery?) trial, matted nodes with gross extracapsular extension (ECE), a risk factor for locoregional recurrence, were an indication for axillary lymph node dissection (ALND), but the effect of microscopic ECE (mECE) in the sentinel lymph nodes (SLNs) on recurrence was not examined.

Methods

Between 2010 and 2017, 811 patients with cT1-2N0 breast cancer and SLN metastasis were prospectively managed according to Z0011 criteria, with ALND for those with more than two positive SLNs or gross ECE. Management of mECE was not specified. In this study, we compare outcomes of patients with one to two positive SLNs with and without mECE, treated with SLN biopsy alone (n = 685).

Results

Median patient age was 58 years, and median tumor size was 1.7 cm. mECE was identified in 210 (31%) patients. Patients with mECE were older, had larger tumors, and were more likely to be hormone receptor positive and HER2 negative, have two positive SLNs, and receive nodal radiation. At a median follow-up of 41 months, no isolated axillary failures were observed. There were 11 nodal recurrences; two supraclavicular ± axillary, four synchronous with breast, and five with distant failure. The five-year rate of any nodal recurrence was 1.6% and did not differ by mECE (2.3% vs. 1.3%; p = 0.84). No differences were observed in local (p = 0.08) or distant (p = 0.31) recurrence rates by mECE status.

Conclusions

In Z0011-eligible patients, nodal recurrence rates in patients with mECE are low after treatment with SLN biopsy alone, even in the absence of routine nodal radiation. The presence of mECE should not be considered a routine indication for ALND.

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Funding

The preparation of this study was funded in part by NIH/NCI Cancer Center Support Grant No. P30 CA008748 to Memorial Sloan Kettering Cancer Center.

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Authors and Affiliations

  1. Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Andrea V. Barrio MD, Stephanie Downs-Canner MD, Kimberly J. Van Zee MS, MD, Hiram S. Cody III MD, Mary L. Gemignani MD, MPH, Melissa L. Pilewskie MD, George Plitas MD, Mahmoud El-Tamer MD, Laurie Kirstein MD, Deborah Capko MD & Monica Morrow MD

  2. Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Marcia Edelweiss MD

  3. Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Sujata Patil PhD

Authors
  1. Andrea V. Barrio MD
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  2. Stephanie Downs-Canner MD
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  3. Marcia Edelweiss MD
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  4. Kimberly J. Van Zee MS, MD
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  6. Mary L. Gemignani MD, MPH
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  7. Melissa L. Pilewskie MD
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  9. Mahmoud El-Tamer MD
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  11. Deborah Capko MD
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  12. Sujata Patil PhD
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  13. Monica Morrow MD
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Corresponding author

Correspondence to Andrea V. Barrio MD.

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Disclosure

Dr. Andrea V. Barrio has received speaking honoraria from Roche; Dr. Monica Morrow has received honoraria from Genomic Health and Roche; Dr. Kimberly J. Van Zee served on the advisory board of Genomic Health in 2012; and Dr. Mahmoud El-Tamer has received honoraria from Blue Earth Diagnostic. Stephanie Downs-Canner, Marcia Edelweiss, Hiram S. Cody III, Mary L. Gemignani, Melissa L. Pilewskie, George Plitas, Laurie Kirstein, Deborah Capko, and Sujata Patil have no conflict of interest disclosures to report.

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Barrio, A.V., Downs-Canner, S., Edelweiss, M. et al. Microscopic Extracapsular Extension in Sentinel Lymph Nodes Does Not Mandate Axillary Dissection in Z0011-Eligible Patients. Ann Surg Oncol 27, 1617–1624 (2020). https://doi.org/10.1245/s10434-019-08104-1

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  • DOI: https://doi.org/10.1245/s10434-019-08104-1

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