👉A recent consensus statement from the Society of Surgical Oncology and American Society for Radiation Oncology has indicated that “no ink on tumor” is an adequate margin for patients undergoing lumpectomy for invasive breast cancer.
👉This recommendation applies regardless of the molecular phenotype.
👉Although the triple-negative phenotype has been associated with a higher local recurrence rate than other phenotypes, there is no evidence to indicate that these patients benefit from wider excision, including mastectomy, for early-stage breast cancer.
👉The American College of Surgeons Oncology Group Z0011 trial established that for patients with clinical T1 to T2, N0 breast cancer found to have only 1 or 2 positive sentinel nodes who will receive whole breast irradiation as a component of breast conserving therapy, a completion ALND is not required.
👉In that trial, patients were randomized to ALND versus no further surgery, and at a median follow-up of 6.3 years, there were no differences between the groups with respect to locoregional recurrence.
👉Regional recurrences in the ipsilateral axilla were similar between study arms with four (0.9%) patients in the sentinel lymph node dissection alone group compared with two (0.5%) in the ALND group.
👉Although the Z0011 trial accrued only 16% ER/PR-negative patients, there was no indication of a higher risk of axillary recurrence among these patients.
👉REFERENCES
- Adkins FC, Gonzalez-Angulo AM, Lei X, et al. Triple-negative breast cancer is not a contraindication for breast conservation. Ann Surg Oncol. 2011;18:3164-3173.
- Chung A, Gangi A, Mirocha J, et al. Applicability of the ACOSOG Z0011 criteria in women with high-risk node-positive breast cancer undergoing breast conserving surgery. Ann Surg Oncol. 2015;22:1128-1132.
- Giuliano AE, McCall L, Beitsch P, et al. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: the American College of Surgeons Oncology Group Z0011 randomized trial. Ann Surg. 2010;252:426-432.
- Hwang ES, Lichtensztajn DY, Gomez SL, et al. Survival after lumpectomy and mastectomy for early stage invasive breast cancer: the effect of age and hormone receptor status. Cancer. 2013;119:1402-1411.
- Moran MS, Schnitt SJ, Giuliano AE, et al. Society of Surgical Oncology-American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer. J Clin Oncol. 2014;32:1507-1515.
👉Rodrigo Arrangoiz MS, MD, FACS cirujano oncology y cirujano de mamá de Sociedad Quirúrgica S.C en el America British Cowdray Medical Center en la ciudad de Mexico:
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Es experto en el manejo del cáncer de mama.
👉Es miembro de la American Society of Breast Surgeons:
Training:
• General surgery:
• Michigan State University:
• 2004 al 2010
• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:
• Fox Chase Cancer Center (Filadelfia):
• 2010 al 2012
• Masters in Science (Clinical research for health professionals):
• Drexel University (Filadelfia):
• 2010 al 2012
• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:
• IFHNOS / Memorial Sloan Kettering Cancer Center:
• 2014 al 2016
Rodrigo Arrangoiz MS, MD, FACS, FSSO 