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Invited Commentary
December 2015

The Biology Behind the American College of Surgeons Oncology Group Z0011 Trial

Author Affiliations
  • 1Department of Surgery, Stanford University School of Medicine, Palo Alto, California
JAMA Surg. 2015;150(12):1148-1149. doi:10.1001/jamasurg.2015.1716

Sentinel lymph node biopsy has been widely adopted as the standard of care in assessing the axilla for the presence of lymph node metastases in patients diagnosed as having breast cancer.1

The American College of Surgeons Oncology Group Z0011 trial has established a low rate of locoregional recurrence with the omission of axillary lymph node dissection (ALND), with the adjunct of improved systemic therapy as well as radiation therapy in patients with minimal nodal disease. Gross extranodal disease was excluded but microscopic extranodal extension (ENE) was not evaluated. The trial did, however, include lymphovascular invasion with 35.2% in the sentinel lymph node biopsy arm vs 40.6% in the axillary lymph node dissection arm; like ENE, lymphovascular invasion is a poor prognostic indicator.2

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