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    Omission of axillary lymph node dissection for clinically node negative early-stage breast cancer patients.
    Breast Cancer 2015 Nov 23;22(6):657-63. Epub 2014 Apr 23.
    Department of Radiology, University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
    Background: For clinically node negative (N0) breast cancer patients, sentinel node (SN) biopsy (SNB) is a standard technique and complete axillary lymph node dissection (ALND) remains the standard treatment when the SN is positive. However, the American College of Surgeons Oncology Group Z0011 trial and the International Breast Cancer Study Group 23-01 trial showed that SNB without ALND can offer excellent regional control and equal survival compared with ALND for limited macrometastatic and micrometastatic SN involvement, respectively. We retrospectively evaluated axillary control rates in clinically N0 patients who had no axillary surgical treatment.

    Methods: Data on 158 patients who underwent breast-conserving therapy without any axillary surgical procedure between 1994 and 2010 were extracted. The last follow-up was on May 2013, and the overall median follow-up period was 119.0 months.

    Results: Of all 158 patients, 10 (6.3 %) and 3 (1.9 %) developed locoregional and axillary recurrences, respectively. The 10-year locoregional and axillary recurrence rates were 5.8 and 2.1 %, respectively. The 5- and 10-year overall survival rates were 94.0 and 84.8 %, respectively. Cases with axillary recurrence tended to have common risk factors for recurrence.

    Conclusion: Even if SNB and ALND were omitted, local and regional recurrence rates were very low among clinically N0 patients and were at the same levels shown in recent trials. This suggests that at least ALND might be safely avoided in clinically N0 patients without any obvious risk factors regardless of axillary nodal status after SNB.

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    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.
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    John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, CA 90404, USA.
    Background And Objective: Sentinel lymph node dissection (SLND) has eliminated the need for axillary dissection (ALND) in patients whose sentinel node (SN) is tumor-free. However, completion ALND for patients with tumor-involved SNs remains the standard to achieve locoregional control. Few studies have examined the outcome of patients who do not undergo ALND for positive SNs. Read More
    Locoregional Recurrence After Sentinel Lymph Node Dissection With or Without Axillary Dissection in Patients With Sentinel Lymph Node Metastases: Long-term Follow-up From the American College of Surgeons Oncology Group (Alliance) ACOSOG Z0011 Randomized Trial.
    Ann Surg 2016 Sep;264(3):413-20
    *Cedars Sinai Medical Center, Los Angeles, CA †Alliance Statistics and Data Center, Weill Cornell Medicine/New York Presbyterian, New York, NY ‡Alliance Statistics and Data Center, Duke University, Durham, NC §Dallas Surgical Group, Dallas, TX ¶Nashville Breast Center, Nashville, TN ||Morton Plant Hospital, Clear Water, FL **University of Texas Southwestern Medical Center Surgery, Dallas, TX ††McLaren Regional Medical Center, Michigan State University, Flint, MI ‡‡Memorial Sloan-Kettering Cancer Center, New York, NY §§MD Anderson Cancer Center, Houston, TX.
    Background And Objective: The early results of the American College of Surgeons Oncology Group (ACOSOG) Z0011 trial demonstrated no difference in locoregional recurrence for patients with positive sentinel lymph nodes (SLNs) randomized either to axillary lymph node dissection (ALND) or sentinel lymph node dissection (SLND) alone. We now report long-term locoregional recurrence results.

    Methods: ACOSOG Z0011 prospectively examined overall survival of patients with SLN metastases undergoing breast-conserving therapy randomized to undergo ALND after SLND or no further axillary specific treatment. Read More
    Sentinel node biopsy in early breast cancer: lessons learned from more than 1000 cases at a single institution.
    Tumori 2012 Jul-Aug;98(4):413-20
    Clinical Surgery Unit, University of Sassari, Sassari, Italy.
    Aims: The aims of this paper are to report the development of sentinel node biopsy (SNB) in breast cancer at a single institution and to discuss the relevant issues on SNB still to be elucidated.

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    Conservative axillary surgery in breast cancer patients undergoing mastectomy: long-term results.
    J Am Coll Surg 2014 Apr 17;218(4):819-24. Epub 2014 Jan 17.
    Division of Surgical Oncology and Breast Services, Department of General Surgery, Cleveland Clinic, Cleveland, OH.
    Background: Recently, the American College of Surgeons Oncology Group Z0011 trial demonstrated that axillary lymph node dissection (ALND) could be safely avoided in selected breast cancer patients with limited nodal disease and having breast conservation therapy. However, for node positive (N+) mastectomy patients, full ALND remains the standard of care. Hypothesizing that omission of complete ALND is safe in many N+ breast cancer patients, a hybrid procedure called conservative axillary regional excision (CARE) was developed, consisting of removal of sentinel nodes and other palpable nodes (without intraoperative frozen section or reoperation for N+). Read More