In Reply: Dr Jatoi states that ER positivity prolongs time to distant relapse, but studies with extended follow-up do not indicate that it prolongs interval to axillary recurrence.1-3 Moreover, because the proportion of ER-negative patients was identical in the 2 treatment groups of Z0011 (16.5% ALND, 16.3% SLND alone), the risk of late recurrences should be evenly distributed. Study results are unlikely to change substantially with further follow-up.
Giuliano AE, Morrow M, Ballman KV. Axillary vs Sentinel Lymph Node Dissection for Invasive Breast Cancer—Reply. JAMA. 2011;305(22):2288–2291. doi:10.1001/jama.2011.756
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