The Z0011 trial demonstrated no significant difference in axillary recurrence rate or survival with or without axillary lymph node dissection (ALND) in patients with a positive sentinel lymph node biopsy (SLNB) for early breast cancer. However, ALND may provide accurate pathological staging information to guide adjuvant therapy. Thus, the role of ALND after positive SLNB remains controversial.
The study aimed to determine patient preferences for ALND versus no further surgical intervention after a positive SLNB for early breast cancer.
Patients who had undergone ALND after positive SLNB as part of breast conserving therapy for early breast cancer were provided with an introductory letter and a validated, self-rated questionnaire. The questionnaire comprised two trade-off questions based on standardised, hypothetical scenarios, and specifically stated that ALND might not provide a survival benefit. Social, demographic and clinical details were collected.
Ninety-nine of the 126 eligible patients (78.6%) completed and returned the questionnaire. The mean age of the participants was 61 years. Most women (92.1%) had 1–2 positive sentinel nodes. Seventy-five percent of participants indicated that they would have ALND even if the chance of side-effects that they had experienced with surgery was 100%. There was no significant association between the side effects that the participants had experienced and their preferences. Married patients were more likely to choose ALND than single patients (p<0.042).
Patients with early breast cancer were found to have a preference for ALND after positive SLNB for additional staging information without evidence of a survival benefit.