[169] Internal Impact of ACOSOG Z0011 at a Tertiary Academic Center

Dana Jaggessarsingh, Bryan Harmon, Brian O'Hea, Patricia Farrelly, Rizk Christine, Tornos Carmen, Meenakshi Singh. Stony Brook University Medical Center, Stony Brook, NY

Background: The ACOSOG Z011 trial in women with T1/T2 breast cancer with up to 3 positive sentinel nodes treated with lumpectomy followed by systemic therapy found no significant loco-regional, overall or disease free survival differences when patients underwent SLNB alone vs. SLNB and complete axillary node dissection(ALND). One conclusion of the study was that in this selected patient group frozen section is unnecessary since they will not undergo immediate ALND. Our study aimed to determine the impact of this trial on the practice of 4 sub-specialized breast surgeons at our institution, a Tertiary Academic Center.
Design: Our computer database found all breast surgery cases with SLNB done at our institution in the 6 months prior to publication of the trial results (9/1/10-2/28/11) and the 6 months after (3/1/11-9/1/11). The number of cases, number of SLNs sent as non-frozen vs. frozen specimens, and surgeons who performed each case were analyzed for both periods. Cases were stratified by surgeon to analyze whether the differences in surgical practice were surgeon dependent.
Results: There were 102 cases performed before the publication which included 279 SLNs, and 106 cases done after which included 339 SLNs. The proportion of lymph nodes sent non-frozen vs. frozen was greater in the 6 months after the publication: 1.4% vs 17.7% (p value of <0.0001). SLNBs were sent more frequently as non-frozen specimens by 2 out of 4 surgeons post trial. Prior to the publication, these two surgeons submitted 3 out of 150 (2%) SLNs as non-frozen while afterwards they submitted 60 out of 179 (33.5%) (p value of <0.0001). The remaining 2 surgeons showed no alteration in practice submitting 1 out of 129 (<1%) non-frozen SLNs pre-trial and 0 out of 160 (0%) non-frozen SLNs post-trial.
Conclusions:

Table 1: # of SLNs sent non-frozen v. frozen before ACOSOG Z011 data by individual surgeons

	Surgeon 1	Surgeon 2	Surgeon 3	Surgeon 4	Total
Non-Frozen SLN	3	0	1	0	4 (1.4%)
Frozen SLN	117	30	76	52	275 (98.6%)
Total	120	30	77	52	279

Table 2: # of SLNs sent non-frozen v. frozen after ACOSOG Z011 data by individual surgeons

	Surgeon 1	Surgeon 2	Surgeon 3	Surgeon 4	Total
Non-Frozen SLN	50	10	0	0	60 (17.7%)
Frozen SLN	88	31	77	83	279 (82.3%)
Total	138	41	77	83	339

The ACOSOG Z011 trial has impacted the surgical practice and treatment of breast cancer patients in some academic institutions. At our institution there has been a dramatic increase and trend towards non-frozen rather that frozen SLNBs, although there still remains individual variability among surgeons.
Category: Breast

Monday, March 19, 2012 2:15 PM

Platform Session: Section B, Monday Afternoon