Impact of ACOSOG Trial Results in the Practice of Breast Cancer Surgery in Long Island: Survey of 19 Hospitals
Dimple Pandya, Jingxuan Liu, Meenakshi Singh, Philip Kane, Carmen Tornos. Stony Brook University Medical Center, Stony Brook, NY
Background: The ACOSOG Z011 trial in women with T1 or T2 breast cancer with up to 3 positive sentinel nodes treated with lumpectomy followed by systemic therapy found no significant differences in loco-regional recurrence, overall survival or disease free survival when patients underwent sentinel lymph node biopsy (SLNB) alone versus SLNB and complete axillary node dissection (ALND). The study implied that frozen section (FS) in selected patients is not necessary since they will not undergo immediate ALND. Our study was aimed to determine the impact of this trial on the daily practice of breast cancer surgery in Long Island.
Design: A telephone survey was done with pathologists from all Long Island Hospitals covering two counties. The survey included: number of surgeons providing breast cancer care specifying general surgeons vs breast surgeons, existence of a breast or general tumor board, routine practice of SLNB by surgeons including frozen sections, routine pathology done on SLN, discussion of ACOSOG results between pathologists and surgeons, changes observed after ACOSOG results were published regarding number of FS requested, and pathology work done on SLN.
Results: A total of 19 hospitals were surveyed including 1 academic center, and 18 community hospitals. 8 hospitals had general surgeons doing all the cases, 9 had both general and breast surgeons and 2 hospitals had breast surgeons. 18 hospitals had all surgeons routinely performing SLNB. In one hospital, one of the two surgeons did not routinely do SLNB. All hospitals but one routinely do immunostains in SLN, and all but one do also levels. 14 hospitals had tumor boards with discussion of breast cases. 5 hospitals had discussed ACOSOG results between pathologists and surgeons. Only one surgeon in a community hospital stopped requesting frozen section on sentinel lymph node and also stopped performing axillary lymph node dissection as per ACOSOG recommendations. One surgeon in another hospital made the request of no immunostain on sentinel nodes but the hospital pathologists did not change the practice. No hospital has changed the pathology work up of SLN after this publication.
Conclusions: Long Island hospitals treat approximately 2,400 new cases a year. Despite these numbers, and despite the presence of one academic institution in the survey, only one surgeon in one community hospital has made changes in the daily practice of SLNB. Pathology work up of SLN in all hospitals remains unchanged.
Wednesday, March 21, 2012 9:30 AM
Poster Session V # 18, Wednesday Morning