Where Do Surgeons Stand on Axillary Dissection in Early Breast Cancer?
Posted: Wednesday, September 12, 2018
Surveyed breast surgeons in the state of Georgia and Los Angeles were divided on whether they would manage axillary dissection based on sentinel node status in women with early-stage breast cancer. Thus, acceptance of recent American College of Surgeons Oncology Group (ACOSOG) Z0011 findings—demonstrating the safety of sentinel node biopsy alone in clinically node-negative women with metastases in one or two sentinel nodes treated with breast conservation—is not as widespread as it might be. The survey results were published in JAMA Oncology.
Of the 376 respondents, “49% would definitely or probably recommend axillary dissection for 1 sentinel node macrometastasis and 63% would definitely or probably recommend axillary dissection for 2 sentinel node macrometastases”—counter to ACOSOG Z0011 results—wrote Monica Morrow, MD, of New York’s Memorial Sloan Kettering Cancer Center, and colleagues. The mean age of the surgeons was 53.7, and about three-quarters of them were male.
On a multivariable analysis, axillary dissection decisions in accordance with ACOSOG Z0011 were associated with surgeons who performed more breast surgeries (P < .001), suggesting “the potential for overtreatment of many patients and the need for education targeting lower-volume breast surgeons,” according to the authors. The surgeons more likely to be ACOSOG Z0011–accordant also preferred minimal surgical margins (P < .001), participated more in multidisciplinary tumor boards (P = .02), and were located in Los Angeles versus Georgia (P = .04).
“This study shows substantial variation in surgeon acceptance of more limited surgery for breast cancer, which is associated with higher breast cancer volume and multidisciplinary interactions,” concluded Dr. Morrow and colleagues. “Development of an evidence-based, practical guideline outlining acceptable alternatives to axillary lymph node dissection in patient subgroups should be a priority.”