ACOSOG Z1071 Trial

  • The ACOSOG Z1071 trial:
    • Was designed to determine the false negative rate (FNR) of:
      • Sentinel lymph node (SLN) surgery after chemotherapy:
        • In women initially presenting with cN1 disease
    • It enrolled women from 136 institutions:
      • Who had clinical:
        • T0 through T4
        • N1 through N2
        • M0 breast cancer
          • Who received neoadjuvant chemotherapy
    • Patients enrolled had:
      • Pre-chemotherapy axillary nodal disease confirmed by:
        • Fine-needle aspiration or
        • Core needle biopsy
    • Following chemotherapy:
      • Patients underwent:
        • Both SLN surgery and axillary lymph node dissection
    • Sentinel lymph node surgery:
      • Using both:
        • Blue dye (isosulfan blue or methylene blue) and a radiolabeled colloid mapping agent:
          • Was encouraged
    • Rates of detection of at least:
      • One SLN were:
        • 92.9% in patients:
          • With cN1 disease and
        • 89.5% in patients:
          • With cN2 disease
    • Overall the FNR of SLN after neoadjuvant chemotherapy was:
      • 12.6%:
        • 90% Bayesian Credible Interval, 9.85%–16.05%
    • Bivariable analyses found that:
      • The likelihood of a false-negative SLN finding was significantly decreased:
        • When the mapping was performed:
          • With the combination of blue dye and radiolabeled colloid:
            • P=.05; FNR:
              • 10.8% combination vs 20.3% single agent and
          • By examination of at least 3 SLNs:
            • P=.007; FNR:
              • 9.1% for ≥3 SLNs vs 21.1% for 2
    • While the study overall did not meet the predetermined acceptability threshold of:
      • Postneoadjuvant SLN biopsy FNR being 10% or less:
        • The authors concluded that:
          • Changes in approach and
          • Patient selection:
            • That result in greater sensitivity would be necessary to support the use of SLN surgery as an alternative to axillary lymph node dissection in this patient population

REFERENCES

  1. Boughey JC, Suman VJ, Mittendorf EA, et al; Alliance for Clinical Trials in Oncology. Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) clinical trial. JAMA. 2013;310:1455-1461.

#Arrangoiz #BreastSurgeon #BreastSurgery #CancerSurgeon #SurgicalOncologist #BreastCancer

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