1. The removal of axillary nodes is:
c. enhances survival
d. prevents lymphedema
2. Based on this study ALND is:
a. no longer necessary
b. is statistically the same as ALND
c. is already supplanted by sentinel lymph node biopsy.
d. is not indicated for patients undergoing mastectomy.
3. Regional Recurrences were more common in:
a. the hormone receptor negative group
b. the Grade 3 cancers
c. the Grade 2 cancers
d. The molecular high risk patients.
Please feel free to comment on any or all of the questions above. We look forward to hearing from you, the Annals readers. This article can be accessed for free.
Answers to Questions:
1. B is the correct answer as ALND prognosticates survival even in the face of Oncotype DX. In other words it is additive to molecular testing. Predictive refers to whether the patient will respond to a given therapy. This study as well as the NSABP B04 trial and others do not show any survival advantage to removing clinically normal nodes. There is however an increased risk of lymphedema with ALND.
2. C is the correct answer. ALND still has a use for clinically positive nodes and for local regional recurrences. ALND for staging has been supplanted by SLNB according to the results of the NSABP B-32 trial. This study is underpowered to show a statistically significant difference but the long follow-up is clinically significant in terms of treating older patients. However, these results as well as those of the ACOSOG Z0011 trial cannot be extrapolated to patients undergoing mastectomy.
3. C is the correct answer meaning that in this study the characteristics of the primary tumor did not dictate regional recurrence. Although molecular testing was not done in this study, Oncotype scores do not predict lymph node positivity or recurrence.