Abstract P2-01-16: Comparison of axillary nodal status between different defined clinically node negative breast cancer: Is ACOSOG Z0011 criteria applicable to preoperative cytologically negative axilla?
Authors: Liang Y , Chen X , Zhu Y , Wu J , Huang O , Zong Y , Zhu S , Gao W , He J , Zhu L , Chen W , Li Y , Shen K 
Published: March 2017

Background Axillary ultrasound (AUS) and US-guided fine-needle aspiration (FNA) are now part of the preoperative axillary assessment. The ACOSOG Z0011 trial demonstrated axillary lymph node dissection (ALND) may be omitted in patients with T1-2 tumor, clinically negative axilla and 1-2 positive sentinel lymph nodes (SLN). But for clinically node negative patients with AUS suspicious but FNA negative axilla, whether they could receive the same surgical procedure and omit ALND referencing to Z0011 criteria as clinically node negative patients identified by AUS has not been illustrated. The purpose of this study was to evaluate potential differences in axillary lymph node (ALN) metastatic status between clinically node negative patients identified by AUS (AUS group) and FNA (FNA group).

Methods Patients with T1-2 tumor and clinically negative axilla treated in Shanghai Ruijin Hospital from Jan 2013 to Dec 2015 were enrolled. ALN metastatic status were compared between AUS group and FNA group.

Results A total of 1007 patients were included. Preoperative axillary status (AUS negative or FNA negative) did not differ significantly between ALN positive and ALN negative patients (p = 0.170). Similarly, ALN metastatic status (negative, 1-2 positive or ≥3 positive) did not differ significantly between AUS group and FNA group (p = 0.405)

table 1. ALN status of patients with different defined clinically node negative breast cancer AUS group N = 886 (%)FNA group N = 121 (%)P valueALN status  0.405Negative740 (83.5)95 (78.5) 1-2 positive125 (14.1)125 (14.1) ≥3 positive21 (2.4)4 (3.3) 

Subset analysis of patients fulfilling Z0011 eligibility criteria showed no significant difference in nonsentinel lymph node (NSLN) metastasis rate (p = 0.591) and number of positive lymph nodes (p = 0.777) between AUS group and FNA group.

table 2. Nodal status of 1-2 SLN positive patients with different defined clinically node negative breast cancer AUS group N = 138 (%)FNA group N = 24 (%)P valueNSLN  0.591Positive27 (19.6)3 (12.5) Negative111 (80.4)21 (87.5) Number of positive lymph nodes  0.777194 (68.1)13 (9.4) 231 (22.5)4 (16.7) 3 or more13 (9.4)2 (8.3) 

Conclusions Patients with clinically node negative axilla identified by FNA were comparable to those identified by AUS in ALN metastatic status. Indicating that patients with preoperative FNA negative axilla could receive the same surgical procedure and may omit ALND referencing to Z0011 criteria as preoperative AUS negative patients.

Citation Format: Liang Y, Chen X, Zhu Y, Wu J, Huang O, Zong Y, Zhu S, Gao W, He J, Zhu L, Chen W, Li Y, Shen K. Comparison of axillary nodal status between different defined clinically node negative breast cancer: Is ACOSOG Z0011 criteria applicable to preoperative cytologically negative axilla? [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-01-16.